Provider Demographics
NPI:1073824983
Name:LEREW, MELANIE RUYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:RUYLE
Last Name:LEREW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BURNSIDE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1123
Mailing Address - Country:US
Mailing Address - Phone:940-264-5500
Mailing Address - Fax:940-264-5500
Practice Address - Street 1:1 BURNSIDE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1123
Practice Address - Country:US
Practice Address - Phone:940-264-5500
Practice Address - Fax:940-264-5503
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ4448207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program