Provider Demographics
NPI:1568447233
Name:MELENDEZ, IVAN G (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:G
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IVAN
Other - Middle Name:GILBERTO
Other - Last Name:MELENDES BAEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1018 BEECH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4547
Mailing Address - Country:US
Mailing Address - Phone:956-800-5171
Mailing Address - Fax:956-800-5178
Practice Address - Street 1:1018 BEECH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4547
Practice Address - Country:US
Practice Address - Phone:956-800-5171
Practice Address - Fax:956-800-5178
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5188207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139915634OtherINDIVIDUAL CHSCN
TX8GK771OtherBCBS - IVANA
TX139915625Medicaid
TX139915633Medicaid
TX139915635Medicaid
TX8U5314OtherBLUE CROSS BLUE SHIELD
TXP00258990OtherRAILROAD MEDICARE
TX319701ZW6ZOtherMEDICARE -IVANA
TXP01802108OtherRR MEDICARE- IVANA