MEDICARE: DR. MELODY RENE VANDER STRATEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	M1393	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8BS530	OTHER	TX	BCBS
3	P01539122	OTHER	TX	RRMC PTAN
4	8M7132	OTHER	TX	BCBS OF TEXAS INDIVIDUAL #

General Provider Information

NPI Number	:	1730151549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELODY RENE VANDER STRATEN MD

Provider Business Mailing Address
First Line	:	12221 N MOPAC EXPY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-2401
Country	:	US
Telephone Number	:	512-681-5900
Fax Number	:	512-681-5922

Provider Business Practice Location Address
First Line	:	5145 N FM 620 RANCH ROAD, BLDG I
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-1815
Country	:	US
Telephone Number	:	512-681-5900
Fax Number	:	512-681-5922

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	12/29/2015

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