Provider Demographics
NPI:1356329502
Name:HISCOCK, MELINDA J (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:J
Last Name:HISCOCK
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 1:3023 PERRYTON PKWY
Mailing Address - Street 2:STE 202
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-2821
Mailing Address - Country:US
Mailing Address - Phone:806-665-1500
Mailing Address - Fax:806-665-1502
Practice Address - Street 1:3023 PERRYTON PKWY
Practice Address - Street 2:STE 202
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2821
Practice Address - Country:US
Practice Address - Phone:806-665-1500
Practice Address - Fax:806-665-1502
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3677207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4564Medicare Oscar/Certification
TXF90849Medicare UPIN
TX8F4564Medicare PIN