MEDICARE: MR. RAY J MELCHIORRE L.A.T.

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	247200000X	Other Technician	AT 1008	TX

General Provider Information

NPI Number	:	1851356703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAY J MELCHIORRE L.A.T.

Provider Business Mailing Address
First Line	:	PO BOX 569
Second Line	:
City	:	PATTISON
State	:	TX
Zip	:	77466-0569
Country	:	US
Telephone Number	:	713-882-1664
Fax Number	:

Provider Business Practice Location Address
First Line	:	6450 ADAMS FLAT RD
Second Line	:
City	:	BROOKSHIRE
State	:	TX
Zip	:	77423-2473
Country	:	US
Telephone Number	:	713-882-1664
Fax Number	:

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/08/2007

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