Provider Demographics
NPI:1609978261
Name:BEAN, MELISSA ANN (DO, MBA, MPH, FACOEM)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:BEAN
Suffix:
Gender:F
Credentials:DO, MBA, MPH, FACOEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 BELLINGTON LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8118
Mailing Address - Country:US
Mailing Address - Phone:314-514-9798
Mailing Address - Fax:
Practice Address - Street 1:5757 PHANTOM DR
Practice Address - Street 2:SUITE 400
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2429
Practice Address - Country:US
Practice Address - Phone:314-513-9404
Practice Address - Fax:314-513-9515
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3F29207Q00000X, 2083P0500X
WI22965-0212083P0500X
TXL86112083P0500X
IL2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine