Provider Demographics
NPI:1952377442
Name:MEASE, DARRELL ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:ROBERT
Last Name:MEASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:MEASE MEDICAL
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346
Mailing Address - Country:US
Mailing Address - Phone:918-253-6418
Mailing Address - Fax:918-253-4066
Practice Address - Street 1:659 S. 14TH ST.
Practice Address - Street 2:BLDG. B
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346
Practice Address - Country:US
Practice Address - Phone:918-253-6418
Practice Address - Fax:918-253-4066
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE68787Medicare UPIN