Provider Demographics
NPI:1336198472
Name:BARRON, MELANIE C (DO)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:C
Last Name:BARRON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 9TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3903
Mailing Address - Country:US
Mailing Address - Phone:817-336-7171
Mailing Address - Fax:817-332-8076
Practice Address - Street 1:909 9TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3903
Practice Address - Country:US
Practice Address - Phone:817-336-7171
Practice Address - Fax:817-332-8076
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7977207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167058002Medicaid
TXP00918499OtherRAILROAD MEDICARE
TX8X9565OtherBCBS
TX8X9565OtherBCBS
TXI08462Medicare UPIN
TX167058002Medicaid
TX313156YNGSMedicare PIN