Provider Demographics
NPI:1063405090
Name:PATTON, MELANIE CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:CHRISTINE
Last Name:PATTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:623-434-6467
Mailing Address - Fax:623-434-6472
Practice Address - Street 1:3648 W ANTHEM WAY
Practice Address - Street 2:A-100
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-7001
Practice Address - Country:US
Practice Address - Phone:623-434-6444
Practice Address - Fax:623-434-6448
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI21565Medicare UPIN
AZ100055Medicare ID - Type Unspecified