Provider Demographics
NPI:1407858707
Name:COLLINS, MELANIE ALICE (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ALICE
Last Name:COLLINS
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 1:12201 RENFERT WAY
Mailing Address - Street 2:STE 205
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5369
Mailing Address - Country:US
Mailing Address - Phone:512-339-6626
Mailing Address - Fax:512-425-3809
Practice Address - Street 1:12201 RENFERT WAY
Practice Address - Street 2:STE 205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5369
Practice Address - Country:US
Practice Address - Phone:512-339-6626
Practice Address - Fax:512-425-3809
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1941207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132605007Medicaid
TX132605007Medicaid