Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | M2399 | TX |
NPI | 1003853441 |
---|---|
Provider Name | Vladimir Melnikov |
First Address | Dallas, TX 75303-1173 |
Second Address | Houston, TX 77030-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 15/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
146529601 | (05) | TX |
8B0313 | BCBS (01) | TX |
H48553 | (02) |