Basic Information
| Provider Information | |||||||||
| NPI: | 1972794154 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMADOR | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | SUZANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13111 EAST FWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770155803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133300766 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13111 EAST FWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770155803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133300766 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 02/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N8267 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | N8267 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RA0000X | BP1-0029056 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4642157052 | 01 | MYUTMB 4642157052 | OTHER |