Provider Demographics
NPI:1043207962
Name:MELVIN, JOHN THAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THAMES
Last Name:MELVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75653-0854
Mailing Address - Country:US
Mailing Address - Phone:903-657-1251
Mailing Address - Fax:903-657-3122
Practice Address - Street 1:701 N HIGH ST
Practice Address - Street 2:SUITE C
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-5983
Practice Address - Country:US
Practice Address - Phone:903-657-1251
Practice Address - Fax:903-657-3122
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG53702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110139601Medicaid
TXE77057Medicare UPIN
TX00DA27Medicare PIN