Provider Demographics
NPI:1962444166
Name:MELTON, CHARLES L (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:MELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2604 SAINT MICHAEL DR
Mailing Address - Street 2:STE 345
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2379
Mailing Address - Country:US
Mailing Address - Phone:903-838-5500
Mailing Address - Fax:903-838-7402
Practice Address - Street 1:2604 SAINT MICHAEL DR
Practice Address - Street 2:STE 345
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2379
Practice Address - Country:US
Practice Address - Phone:903-838-5500
Practice Address - Fax:903-838-7402
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF6942207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128230001Medicaid
AR3250610OtherBLUE LINK
OK100150730AMedicaid
TX8G3790OtherBCBS OF TEXAS
AR19559000040OtherQUAL CHOICE
AR97146OtherBCBS OF ARKANSAS
O60068553OtherRAILROAD
TX0004314459OtherAETNA
TX047791102Medicaid
TX0004314459OtherAETNA
AR128230001Medicaid