Provider Demographics
NPI:1316050081
Name:MELENDEZ, TERRY D (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:D
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1248 E 90 N
Mailing Address - Street 2:# 300
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2956
Mailing Address - Country:US
Mailing Address - Phone:801-756-9635
Mailing Address - Fax:801-216-8357
Practice Address - Street 1:120 N 1220 E
Practice Address - Street 2:STE 7
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2089
Practice Address - Country:US
Practice Address - Phone:801-756-9635
Practice Address - Fax:801-756-8020
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT3205681205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG32098Medicare UPIN
UT000055129Medicare ID - Type Unspecified