Provider Demographics
NPI:1235339037
Name:HAFFORD, MELANIE LYNETTE (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNETTE
Last Name:HAFFORD
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 1:2021 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2219
Mailing Address - Country:US
Mailing Address - Phone:972-253-2560
Mailing Address - Fax:972-253-4218
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-823-3230
Practice Address - Fax:972-401-0458
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN9060208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3054553 04Medicaid
TX1235339037OtherBLUE CROSS BLUE SHIELD
TX305455301Medicaid
TX3054553 04Medicaid
TX305455301Medicaid