Provider Demographics
NPI:1518107051
Name:MREYOUD, AMJAD (MD)
Entity Type:Individual
Prefix:DR
First Name:AMJAD
Middle Name:
Last Name:MREYOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5726
Mailing Address - Country:US
Mailing Address - Phone:918-294-6840
Mailing Address - Fax:918-294-6839
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-294-6840
Practice Address - Fax:918-294-6839
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26690207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200247540AMedicaid
OKOKA102338Medicare PIN