Provider Demographics
NPI:1306973979
Name:TUCK-WHITE, MELISSA S (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:S
Last Name:TUCK-WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5050 POWDERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4800
Mailing Address - Country:US
Mailing Address - Phone:307-634-1311
Mailing Address - Fax:307-634-1271
Practice Address - Street 1:410 S RAMPART BLVD STE 420
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5749
Practice Address - Country:US
Practice Address - Phone:702-240-4200
Practice Address - Fax:702-548-4253
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM9065207Q00000X
WY10309A207Q00000X
CODR.0057992207Q00000X
NV23624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192649501Medicaid
TX192649501Medicaid
TX8K4191Medicare PIN