Individual
LISSA M MELVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5414 FREDERICKSBURG RD, SUITE 200, SAN ANTONIO, TX 78229
(210) 614-2209
(210) 614-5714
Mailing address
5414 FREDERICKSBURG RD, SUITE 200, SAN ANTONIO, TX 78229
(210) 614-2209
(210) 614-5714
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
042041
CT
207VG0400X
Gynecology Physician
M6738
TX
207VM0101X
Maternal & Fetal Medicine Physician
Primary
M6738
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001420413
—
CT
05
—
1867277-01
—
TX
Enumeration date
11/22/2005
Last updated
11/07/2019
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