Healthcare Provider Details

I. General information

NPI: 1952377442
Provider Name (Legal Business Name): DARRELL ROBERT MEASE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 S. 14TH ST. BLDG. B
JAY OK
74346
US

IV. Provider business mailing address

MEASE MEDICAL
JAY OK
74346
US

V. Phone/Fax

Practice location:
  • Phone: 918-253-6418
  • Fax: 918-253-4066
Mailing address:
  • Phone: 918-253-6418
  • Fax: 918-253-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16931
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: