Healthcare Provider Details

I. General information

NPI: 1356329502
Provider Name (Legal Business Name): MELINDA J HISCOCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 PERRYTON PKWY STE 202
PAMPA TX
79065-2821
US

IV. Provider business mailing address

3023 PERRYTON PKWY STE 202
PAMPA TX
79065-2821
US

V. Phone/Fax

Practice location:
  • Phone: 806-665-1500
  • Fax: 806-665-1502
Mailing address:
  • Phone: 806-665-1500
  • Fax: 806-665-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberJ3677
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: