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NPI Code Detail

MEDICARE: MELITA LANG BROOKS MD

MEDICARE: MELITA LANG BROOKS MD
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
1207Q00000XFamily Medicine PhysicianJ1501TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1117314OTHERTXCHIPS
2752616977028OTHERTXTRICARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4138737515OTHERTXEPSDT
58S1460OTHERTXBCBS OF TEXAS

General Provider Information

NPI Number : 1366430332
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELITA LANG BROOKS MD
Provider Business Mailing Address
First Line : PO BOX 846098
Second Line :
City : DALLAS
State : TX
Zip : 75284-6098
Country : US
Telephone Number : 903-324-6450
Fax Number :
Provider Business Practice Location Address
First Line : 3202 S MAIN ST
Second Line :
City : LINDALE
State : TX
Zip : 75771-7727
Country : US
Telephone Number : 903-882-0991
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2005
Last Update Date : 10/10/2014

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