Provider Demographics
NPI:1760650428
Name:CONROY, MELINDA DAWN (DO)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:DAWN
Last Name:CONROY
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 1:401 RANCH ROAD 620 S STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5304
Mailing Address - Country:US
Mailing Address - Phone:512-610-0549
Mailing Address - Fax:512-666-3744
Practice Address - Street 1:401 RANCH ROAD 620 S STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5304
Practice Address - Country:US
Practice Address - Phone:512-610-0549
Practice Address - Fax:512-540-8853
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6231207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CK978OtherBCBS IND. NUMBER
TX215686101Medicaid
TXTXB108908Medicare PIN
TXTXB108910Medicare PIN