Provider Demographics
NPI:1912083841
Name:DEUTER, MELISSA S (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:DEUTER
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 1:18587 SIGMA RD STE 260
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4205
Mailing Address - Country:US
Mailing Address - Phone:210-314-4564
Mailing Address - Fax:210-615-6966
Practice Address - Street 1:18587 SIGMA RD STE 260
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4205
Practice Address - Country:US
Practice Address - Phone:210-692-7800
Practice Address - Fax:210-615-6966
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL77132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610540Medicare ID - Type Unspecified
I06009Medicare UPIN