Provider Demographics
NPI:1750648895
Name:MEDLEY, MELISSA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KAY
Last Name:MEDLEY
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 1:250 E BASSE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-8409
Mailing Address - Country:US
Mailing Address - Phone:210-224-4811
Mailing Address - Fax:210-224-1573
Practice Address - Street 1:250 E BASSE RD STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-8409
Practice Address - Country:US
Practice Address - Phone:210-224-4811
Practice Address - Fax:210-224-1573
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9199207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-61173OtherBCBS OF AL