Provider Demographics
NPI:1083684609
Name:BOBADILLA, MELISSA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:S
Last Name:BOBADILLA
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 1:1527 BROWN ST STE C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4737
Mailing Address - Country:US
Mailing Address - Phone:915-533-5200
Mailing Address - Fax:915-533-5214
Practice Address - Street 1:1527 BROWN ST STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4737
Practice Address - Country:US
Practice Address - Phone:915-533-5200
Practice Address - Fax:915-533-5214
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8918174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096575801Medicaid
TX096575801Medicaid
TX00382LMedicare PIN