Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD43691 | TN |
NPI | 1033144647 |
---|---|
Provider Name | Dr. Mark R Melson |
First Address | Glasgow, KY 42141-3412 |
Second Address | Nashville, TN 37205-2205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/06/2017 |