Individual
CHARLES L MELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2604 SAINT MICHAEL DR, STE 345, TEXARKANA, TX 75503-2379
(903) 838-5500
(903) 838-7402
Mailing address
2604 SAINT MICHAEL DR, STE 345, TEXARKANA, TX 75503-2379
(903) 838-5500
(903) 838-7402
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
F6942
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004314459
AETNA
TX
05
—
047791102
—
TX
05
—
100150730A
—
OK
05
—
128230001
—
AR
01
—
19559000040
QUAL CHOICE
AR
01
—
3250610
BLUE LINK
AR
01
—
8G3790
BCBS OF TEXAS
TX
01
—
97146
BCBS OF ARKANSAS
AR
01
—
O60068553
RAILROAD
—
Enumeration date
06/12/2006
Last updated
04/28/2010
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