Provider Demographics
NPI:1558307124
Name:POPP, MELISSA (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:POPP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-6005
Mailing Address - Country:US
Mailing Address - Phone:817-253-6890
Mailing Address - Fax:
Practice Address - Street 1:499 10TH ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114
Practice Address - Country:US
Practice Address - Phone:830-393-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0531207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U6926OtherTXBS FLORESVILLE ER
TX1558307124OtherTRICARE
TX177574410Medicaid
TX177574411Medicaid
TX177574409Medicaid
TX1558307124OtherBCBSTX
TX1558307124OtherTRICARE SOUTH
TX8CA732OtherBC/BS OF TEXAS
TX177574409Medicaid
TXTXB134273Medicare PIN
TX8U6926OtherTXBS FLORESVILLE ER
TX177574410Medicaid
P00722752Medicare PIN