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General NPI Number Information
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NPI Number | 1649215310
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Entity Type | Individual
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Provider Name | BENJY LEE MELANCON A.T.C., L.A.T.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1201 S LINDSAY ST
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City | GAINESVILLE
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State | TX
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Zip | 76240-5661
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Country | US
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Telephone | 940-736-6834
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Fax | 940-665-9265
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Provider Business Mailing Address
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Address Line | 618 S DENTON ST
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City | GAINESVILLE
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State | TX
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Zip | 76240-5326
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Country | US
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Telephone | 940-668-8746
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Fax | 940-668-8746
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1908
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License Number State | TX
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