Provider Demographics
NPI:1366430332
Name:BROOKS, MELITA LANG (MD)
Entity type:Individual
Prefix:
First Name:MELITA
Middle Name:LANG
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELITA
Other - Middle Name:
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:3202 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7727
Practice Address - Country:US
Practice Address - Phone:903-882-0991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117314OtherCHIPS
TX752616977028OtherTRICARE
TX103402703Medicaid
TX138737515OtherEPSDT
TX8S1460OtherBCBS OF TEXAS
TX8S1460OtherBCBS OF TEXAS
TX117314OtherCHIPS
TX8D7896Medicare Oscar/Certification
TX138737515OtherEPSDT