=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700827359
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID WILLIAM MELTZER PH.D., M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2006
-----------------------------------------------------
Last Update Date | 07/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8210 WALNUT HILL LN SUITE 109
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-368-2020
-----------------------------------------------------
Fax | 214-692-7836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8210 WALNUT HILL LN SUITE 109
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-368-2020
-----------------------------------------------------
Fax | 214-692-7836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G4653
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------