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General NPI Number Information
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NPI Number | 1396737888
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Entity Type | Individual
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Provider Name | MELINDA ROTHER ALLEN DO
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Gender | Female
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 100 ELMWOOD AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-3406
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Country | US
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Telephone | 580-716-1778
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Fax | 918-787-2276
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Provider Business Mailing Address
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Address Line | 100 ELMWOOD AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-3406
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Country | US
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Telephone | 580-716-1778
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Fax | 918-787-2276
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 3741
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License Number State | OK
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