Provider Demographics
NPI:1881646255
Name:MELVILLE, DANIEL ELIAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ELIAS
Last Name:MELVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 E SOUTHLAKE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6464
Mailing Address - Country:US
Mailing Address - Phone:817-600-8725
Mailing Address - Fax:833-989-2353
Practice Address - Street 1:1545 E SOUTHLAKE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6464
Practice Address - Country:US
Practice Address - Phone:817-600-8725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41035207Q00000X
LA200658207Q00000X
TXP4352207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine