Provider Demographics
NPI:1760593883
Name:GARRETSON, MELISSA J (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:GARRETSON
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4095
Practice Address - Fax:682-885-7499
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0039207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045265804Medicaid
TX045265805OtherCSHCN
TX10029825OtherAMERIGROUP PIN
TX413457OtherPHCS PIN
TX1640371OtherFIRSTHEALTH PIN
TX8918867OtherCIGNA PIN
TX1392484OtherUHC PIN
1669442042OtherGRP NPI NUMBER
TX5099264OtherAETNA PIN
TX00L42VOtherBCBSTX GRP PIN
TX8A0216OtherBCBSTX IND PIN
TX107950OtherSUPERIOR PIN
TX113333100OtherFIRSTCARE PIN
G30097Medicare UPIN
TX045265804Medicaid