Mellgren, Grace M Sally
Mellgren, Grace M Sally is an individual health care provider with primary practice located at 342 Sherrill Ln , Roswell NM 88201-5819. She recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as her primary health care specialty. Mellgren, Grace M Sally can be contacted via phone (575) 625-0123.Contact Information
Primary practice address
342 Sherrill Ln
Roswell NM 88201-5819
Phone: (575) 625-0123
Fax: (575) 625-0131
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | MD2015-0927 | New Mexico |
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | G53485 | California |
Profile Details
| NPI number | 1184709339 |
|---|---|
| LBN Legal business name | Mellgren, Grace M Sally |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 26th, 2006 |
| Last updated | Apr 10th, 2024 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184709339 | NPPES |
| California | Other | ZZZ07175Z | BLUE SHIELD OF CA |
| California | MEDICAID | 00G53480 | BLUE SHIELD OF CA |
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