Provider Demographics
NPI:1588956361
Name:EFRON-EVERETT, MELISSA F (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:F
Last Name:EFRON-EVERETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13128 N 94TH DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4254
Mailing Address - Country:US
Mailing Address - Phone:623-760-9449
Mailing Address - Fax:623-974-9351
Practice Address - Street 1:13943 N 91ST AVE
Practice Address - Street 2:SUITE C-101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3629
Practice Address - Country:US
Practice Address - Phone:623-972-3992
Practice Address - Fax:623-977-1132
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ50382207N00000X
TXBP20042261207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ34459Medicaid