Healthcare Provider Details

I. General information

NPI: 1194980888
Provider Name (Legal Business Name): JAMES EDWARD MEISSEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S ELM PL SUITE 120
BROKEN ARROW OK
74012-7877
US

IV. Provider business mailing address

6600 S YALE AVE SUITE 1400
TULSA OK
74136-3347
US

V. Phone/Fax

Practice location:
  • Phone: 918-451-5191
  • Fax:
Mailing address:
  • Phone: 918-488-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4665
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4665
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: