Provider Demographics
NPI:1700094497
Name:MELMED, GAVIN MARK (MD)
Entity type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:MARK
Last Name:MELMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:7150 N PRESIDENT GEORGE BUSH HWY STE 200
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2210
Practice Address - Country:US
Practice Address - Phone:972-272-3417
Practice Address - Fax:972-272-2425
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0968207R00000X, 207RX0202X
TXAB2218077-5353390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00942276OtherRAILROAD MEDICARE
TX202382201Medicaid
TX8BZ448OtherBCBS
TX202382202Medicaid
TX8L13295Medicare PIN
TX8BZ448OtherBCBS