Provider Demographics
NPI:1609496561
Name:GERALD, MELISSA RAE (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAE
Last Name:GERALD
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 1:1111 S SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5440
Mailing Address - Country:US
Mailing Address - Phone:918-619-4600
Mailing Address - Fax:918-619-4696
Practice Address - Street 1:1111 S SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5440
Practice Address - Country:US
Practice Address - Phone:918-619-4600
Practice Address - Fax:918-619-4696
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7402390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program