Individual
DR. JUAN F MELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1337 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2046
(417) 967-5435
(417) 967-5503
Mailing address
1337 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2046
(417) 967-5435
(417) 967-5503
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
2014020901
MO
207RP1001X
Pulmonary Disease Physician
35.097185
OH
207RP1001X
Pulmonary Disease Physician
4301042635
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000720256
ANTHEM
OH
01
—
000000722678
ANTHEM
OH
05
—
0050111
—
OH
05
—
1629185897
—
MI
05
—
1629185897
—
MO
05
—
204079001
—
AR
01
—
26D0889777
CLIA
MO
05
—
3810020716
—
WV
01
—
991084088
MEDICARE PTAN #
MO
Enumeration date
08/24/2006
Last updated
06/13/2016
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