Provider Demographics
NPI:1093702011
Name:MELTON, JIM G (DO)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:G
Last Name:MELTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 QUAIL SPRINGS PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2612
Mailing Address - Country:US
Mailing Address - Phone:405-701-9880
Mailing Address - Fax:405-701-9881
Practice Address - Street 1:3200 QUAIL SPRINGS PKWY
Practice Address - Street 2:STE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-2612
Practice Address - Country:US
Practice Address - Phone:405-701-9880
Practice Address - Fax:405-701-9881
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3168208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK770001792OtherRAILROAD MEDICARE
OK100130690AMedicaid
OKOKA100859Medicare PIN
OK770001792OtherRAILROAD MEDICARE
OKF16473Medicare UPIN
OK24H616535Medicare PIN