Provider Demographics
NPI:1932286069
Name:OKLAHOMA SKIN SURGERY & COSMETIC DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:OKLAHOMA SKIN SURGERY & COSMETIC DERMATOLOGY, P.C.
Other - Org Name:DERMATOLOGY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-293-9933
Mailing Address - Street 1:PO BOX 700390
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-0390
Mailing Address - Country:US
Mailing Address - Phone:918-293-9966
Mailing Address - Fax:918-293-9988
Practice Address - Street 1:1440 TERRACE DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4626
Practice Address - Country:US
Practice Address - Phone:918-293-9966
Practice Address - Fax:918-293-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19511207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG13541Medicare UPIN