Provider Demographics
NPI:1023018819
Name:MYERS, MELISSA B (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:B
Last Name:MYERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 S 129TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-7005
Mailing Address - Country:US
Mailing Address - Phone:800-993-8244
Mailing Address - Fax:404-494-7549
Practice Address - Street 1:4705 S 129TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-7005
Practice Address - Country:US
Practice Address - Phone:918-615-7261
Practice Address - Fax:404-494-7549
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF13923Medicare UPIN