Provider Demographics
NPI:1801854617
Name:MELTON, MARK EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:MELTON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1505 N COMMERCE ST
Mailing Address - Street 2:SUITE #204
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1863
Mailing Address - Country:US
Mailing Address - Phone:580-226-3003
Mailing Address - Fax:580-798-3124
Practice Address - Street 1:1505 N COMMERCE ST
Practice Address - Street 2:SUITE #204
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1863
Practice Address - Country:US
Practice Address - Phone:580-226-3003
Practice Address - Fax:580-798-3124
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-09-16
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Provider Licenses
StateLicense IDTaxonomies
OK2962207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00300469OtherRAILROAD MEDICARE PART B
OK100130510BMedicaid
OK100130510BMedicaid
OK$$$$$$$$$RMedicare PIN