Provider Demographics
NPI:1154329746
Name:MCELYA, MARTIN G (DO)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:G
Last Name:MCELYA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7703
Mailing Address - Country:US
Mailing Address - Phone:972-726-6464
Mailing Address - Fax:972-726-6444
Practice Address - Street 1:5917 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7703
Practice Address - Country:US
Practice Address - Phone:972-726-6464
Practice Address - Fax:972-726-6444
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2011-03-23
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TXK1555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine