Provider Demographics
NPI:1790767135
Name:TEBROCK, MELISSA J (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:J
Last Name:TEBROCK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Mailing Address - Street 2:ATTN: MCEUL-DCCS (CREDENTIALS), CMR 402
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:DE
Mailing Address - Phone:01149637-186-8839
Mailing Address - Fax:01149637-186-6133
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:FAMILY MEDICINE CLINIC, CMR 402
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:DE
Practice Address - Phone:01149637-186-6640
Practice Address - Fax:01149637-186-6051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IN01051936A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine