Provider Demographics
NPI:1477540003
Name:SLOVAK-TUCKER, MELISSA SHANNON (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SHANNON
Last Name:SLOVAK-TUCKER
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 1:1107 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5602
Mailing Address - Country:US
Mailing Address - Phone:903-212-4763
Mailing Address - Fax:903-758-7081
Practice Address - Street 1:2015 MULBERRY AVE
Practice Address - Street 2:STE 250
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2927
Practice Address - Country:US
Practice Address - Phone:903-572-4664
Practice Address - Fax:903-572-4647
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7890207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
123717OtherSUPERIOR HEALTH PLAN
P00174783OtherRAIL ROAD MEDICARE
TX1659385-01Medicaid
8C1022Medicare PIN
I10938Medicare UPIN