Basic Information
| Provider Information | |||||||||
| NPI: | 1528028859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELSON | ||||||||
| FirstName: | GILBERT | ||||||||
| MiddleName: | REID | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2129 HELTON DRIVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356301069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567183200 | ||||||||
| FaxNumber: | 2567183297 | ||||||||
| Practice Location | |||||||||
| Address1: | 2129 HELTON DRIVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356301069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567183200 | ||||||||
| FaxNumber: | 2567183297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 08/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 10886 | AL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000088460 | 05 | AL | MEDICAID |