Provider Demographics
NPI:1669444196
Name:GREER, MELINDA SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:SUE
Last Name:GREER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MELINDA
Other - Middle Name:SUE
Other - Last Name:ROHDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19005 S 580 RD
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-2665
Mailing Address - Country:US
Mailing Address - Phone:918-718-5018
Mailing Address - Fax:918-458-9279
Practice Address - Street 1:48253 US HIGHWAY 271
Practice Address - Street 2:
Practice Address - City:WISTER
Practice Address - State:OK
Practice Address - Zip Code:74966-2390
Practice Address - Country:US
Practice Address - Phone:918-677-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20839208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1120839Medicaid
OKG76175Medicare UPIN