Active NPI
Ellen Gwendolyn Melton, MD
- Pediatrics Physician
- Tyler, TX
National Provider Identifier
1386672434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- F4276
- Practice address
- 1000 5TH Street
Tyler, TX 75701 - Phone
- (903) 590-5555
- Fax
- (903) 590-5005
- NPI assigned
- Jun 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | F4276 | TX | Primary |
Addresses
Primary practice location
1000 5TH Street
Tyler, TX 75701
Mailing address
PO Box 9477
Tyler, TX 75711-9477
Phone (903) 594-2450
Other names 1
- Ellen G Redd
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F4276 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386672434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9477",
"city": "TYLER",
"state": "TX",
"postal_code": "757119477",
"telephone_number": "903-594-2450",
"fax_number": "903-509-0493"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 5TH STREET",
"city": "TYLER",
"state": "TX",
"postal_code": "75701",
"telephone_number": "903-590-5555",
"fax_number": "903-590-5005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELTON",
"first_name": "ELLEN",
"middle_name": "GWENDOLYN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "F4276",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ELLEN",
"last_name": "REDD",
"middle_name": "G",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.