Doctor Name: | DR. GAVIN MARK MELMED |
NPI Number: | 1700094497 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | AB2218077-5353 |
Business Practice Address: | 777 Walter Reed Blvd Suite 201 Garland, TX - 750425727 |
Business Phone Number: | 9722723417 |
Business Fax Number: | 9724871749 |
Mailing Address: | Po Box 911230, DALLAS |
State: | TX |
Postal Code: | 753911230 |
Phone Number: | 9729978000 |
Fax Number: | 9722340813 |
NPI Enumeration Date: | 05/18/2007 |
NPI Last Update Date: | 08/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | AB2218077-5353 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |