Provider Demographics
NPI:1386671220
Name:RASMUSSEN, MELISSA M (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:M
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3930 N PLACITA DE LA ESCARPA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-2354
Mailing Address - Country:US
Mailing Address - Phone:520-275-6493
Mailing Address - Fax:520-326-5309
Practice Address - Street 1:4001 E SUNRISE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4324
Practice Address - Country:US
Practice Address - Phone:520-209-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3381207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ519613Medicaid
H32828Medicare UPIN
AZZ110271Medicare PIN