Healthcare Provider Details

I. General information

NPI: 1093702011
Provider Name (Legal Business Name): JIM G MELTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 QUAIL SPRINGS PKWY STE 200
OKLAHOMA CITY OK
73134-2612
US

IV. Provider business mailing address

3200 QUAIL SPRINGS PKWY STE 200
OKLAHOMA CITY OK
73134-2612
US

V. Phone/Fax

Practice location:
  • Phone: 405-701-9880
  • Fax: 405-701-9881
Mailing address:
  • Phone: 405-701-9880
  • Fax: 405-701-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3168
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number3168
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: