Provider Demographics
NPI:1366423725
Name:CARDENAS, MELCHOR P (MD)
Entity type:Individual
Prefix:
First Name:MELCHOR
Middle Name:P
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 CORPUS CHRISTI ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5277
Mailing Address - Country:US
Mailing Address - Phone:956-725-0300
Mailing Address - Fax:956-722-6174
Practice Address - Street 1:904 CORPUS CHRISTI ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5277
Practice Address - Country:US
Practice Address - Phone:956-725-0300
Practice Address - Fax:956-722-6174
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080191794OtherRAILROAD MEDICARE
TX046869602Medicaid
TX046869603Medicaid
MSH03316OtherMERCY HEALTH PLANS
TX0018HXOtherBCBS OF TEXAS
TX080191794OtherRAILROAD MEDICARE
TX046869602Medicaid