Provider Demographics
NPI:1306936695
Name:GEORGE, MELISSA ANNE (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 S MILAM ST STE 3
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4579
Mailing Address - Country:US
Mailing Address - Phone:830-997-2745
Mailing Address - Fax:830-992-2152
Practice Address - Street 1:1009 S MILAM ST STE 3
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4579
Practice Address - Country:US
Practice Address - Phone:830-997-2745
Practice Address - Fax:830-992-2152
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC0148022OtherDPS NUMBER
TXM4085OtherMEDICAL LICENSE NUMBER
TXBG9928029OtherDEA NUMBER