Individual
MICHAEL RAY MELANCON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4650 AMBASSADOR CAFFERY PKWY, SUITE 105, LAFAYETTE, LA 70508-6926
(337) 989-8080
(337) 981-0913
Mailing address
4650 AMBASSADOR CAFFERY PKWY, SUITE 105, LAFAYETTE, LA 70508-6926
(337) 989-8080
(337) 981-0913
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD015178
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015178
LA STATE LICENSE
LA
05
—
1324833
—
LA
01
—
721165262
FEDERAL TAX ID
LA
Enumeration date
07/06/2006
Last updated
07/08/2007
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