Healthcare Provider Details

I. General information

NPI: 1558372854
Provider Name (Legal Business Name): MELVYN VANROY MAHON MD FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE SUITE 304
TULSA OK
74136-1907
US

IV. Provider business mailing address

6600 S YALE AVE SUITE 1400
TULSA OK
74136-3310
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-5300
  • Fax:
Mailing address:
  • Phone: 918-488-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number12620
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: