=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912227752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD P. MELMED, M.D. P.A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2010
-----------------------------------------------------
Last Update Date | 06/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7777 FOREST LN A210
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-566-7755
-----------------------------------------------------
Fax | 972-566-7979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7777 FOREST LN A210
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-566-7755
-----------------------------------------------------
Fax | 972-566-7979
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. EDWARD PETER MELMED
-----------------------------------------------------
Credential | M.D., P.A
-----------------------------------------------------
Telephone | 972-566-7755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------