MEDICARE: DR. CLELIE CLAIRE CARPENTER MELANCON M.D.

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	S5435	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1255750436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLELIE CLAIRE CARPENTER MELANCON M.D.

Provider Business Mailing Address
First Line	:	6655 TRAVIS ST STE 900
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1336
Country	:	US
Telephone Number	:	713-526-5665
Fax Number	:	713-526-5160

Provider Business Practice Location Address
First Line	:	6655 TRAVIS ST STE 900
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1336
Country	:	US
Telephone Number	:	713-526-5665
Fax Number	:

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	06/10/2020

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