Provider Demographics
NPI:1760587653
Name:MIDGLEY, MELINDA M (MD)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:M
Last Name:MIDGLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2965 W 3500 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3602
Mailing Address - Country:US
Mailing Address - Phone:801-965-3600
Mailing Address - Fax:
Practice Address - Street 1:11724 S STATE ST
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7163
Practice Address - Country:US
Practice Address - Phone:801-576-2092
Practice Address - Fax:801-576-2093
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4792541-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870293873MIDOtherEMIA
UT63122OtherPEHP
UTQM0000046556OtherALTIUS
UT107008945101OtherSELECT HEALTH
UT670074OtherDESERET MUTUAL BENEFIT AS
UTD3560Medicaid
UT87029387384062B002OtherTRICARE
UT47925411200001OtherBLUE CROSS/BLUE SHIELD
UT870293873MIDOtherEMIA
UTQM0000046556OtherALTIUS
UT47925411200001OtherBLUE CROSS/BLUE SHIELD