Dorothy L Mellon, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

017167 Issued in LA

Practice address

1541 Kings Hwy
Shreveport, LA 71103-4228

Phone

(318) 629-0000

Fax

(318) 629-4833

NPI assigned

Jan 17, 2006

Last updated

May 17, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lsu Health Sciences Center Shreveport Faculty Group Practice

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1013374222

  Otolaryngology

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1780663872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 W KIRBY PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 KINGS HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-629-0000",
            "fax_number": "318-629-4833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1502 SE 28th St",
            "address_2": "Suite 6",
            "address_purpose": "LOCATION",
            "city": "Bentonville",
            "state": "AR",
            "postal_code": "727123988",
            "country_code": "US",
            "telephone_number": "479-464-9800",
            "fax_number": "479-464-9801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "LSU Health Shv Otolaryngology -HRM Admin Bldg",
            "address_2": "1501 Kings Hwy., Rm 116",
            "address_purpose": "LOCATION",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711032755",
            "country_code": "US",
            "telephone_number": "479-877-0015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MELLON",
        "first_name": "DOROTHY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-17",
        "last_updated": "2023-05-17",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "LA",
            "license": "017167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149971002",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149961001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie C Frederick
• Gregory Allen Melder, SA-C
• Claire Marie Melebeck, PT
• Mariah Corbell Meleton, LOTR
• Melissa L Lynn MD Apmc
• Aja Welch Menard, M.D.
• Angelique J Menard, M.ED, BCBA, LBA
• Matthew Scott Menard, MD
• Terrell Mendenhall
• Christopher Menefee

• Otolaryngology Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Otolaryngology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.