MEDICARE: MELINDA ROTHER ALLEN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	3741	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110245910	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396737888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA ROTHER ALLEN DO

Provider Business Mailing Address
First Line	:	100 ELMWOOD AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-3406
Country	:	US
Telephone Number	:	580-716-1778
Fax Number	:	918-787-2276

Provider Business Practice Location Address
First Line	:	100 ELMWOOD AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-3406
Country	:	US
Telephone Number	:	580-716-1778
Fax Number	:	918-787-2276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	03/09/2015

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Directions to “ MELINDA ROTHER ALLEN DO” Practice Location

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