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General NPI Number Information
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NPI Number | 1619019239
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Entity Type | Individual
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Provider Name | MELVYN H GENRAICH MD
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 201 E GRANT AVE
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City | MORTON
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State | TX
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Zip | 79346-3444
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Country | US
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Telephone | 806-266-5565
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Fax | 806-266-5342
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Provider Business Mailing Address
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Address Line | 3303 S MERIDIAN AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73119-1026
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Country | US
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Telephone | 806-266-5565
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Fax | 806-266-5342
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E6784
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | E6784
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License Number State | TX
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