Provider Demographics
NPI:1972638948
Name:MELISH, MARK ALAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:MELISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 29384
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0384
Mailing Address - Country:US
Mailing Address - Phone:210-227-5168
Mailing Address - Fax:210-224-6945
Practice Address - Street 1:621 N ALAMO ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1836
Practice Address - Country:US
Practice Address - Phone:210-227-5223
Practice Address - Fax:210-224-6945
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG8278207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC19273Medicare UPIN
TX8A4431Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER