Provider Demographics
NPI:1528093184
Name:MENCER-PARKS, MELANIE (MD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:MENCER-PARKS
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 1:1200 BINZ ST
Mailing Address - Street 2:STE 500
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6934
Mailing Address - Country:US
Mailing Address - Phone:713-522-1221
Mailing Address - Fax:713-522-1210
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:STE 500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6934
Practice Address - Country:US
Practice Address - Phone:713-522-1221
Practice Address - Fax:713-522-1210
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M8480OtherBCBS PIN
TX007662403Medicaid
TX8M8480Medicare PIN
TX007662403Medicaid