Provider Demographics
NPI:1285732487
Name:MELTON, CLINTON G (MD)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:G
Last Name:MELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7337
Mailing Address - Country:US
Mailing Address - Phone:870-698-0300
Mailing Address - Fax:870-698-2924
Practice Address - Street 1:305 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7337
Practice Address - Country:US
Practice Address - Phone:870-698-0300
Practice Address - Fax:870-698-2924
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5164207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1003500001Medicaid
AR1003500001Medicaid