Provider Demographics
NPI:1427252006
Name:MELTON, JENNIFER LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEIGH
Last Name:MELTON
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 1:18850 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4288
Mailing Address - Country:US
Mailing Address - Phone:281-446-7900
Mailing Address - Fax:
Practice Address - Street 1:18850 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4288
Practice Address - Country:US
Practice Address - Phone:281-446-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108594207W00000X
TXP5106207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00308VOtherMEDICARE GROUP PTAN
3862578615OtherMYUTMB 3862578615-COMMERCIAL NUMBER
TX260392YKVCOtherMEDICARE PTAN