MEDICARE: AELAYNA MEYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	62088-20	WI
2	207ND0101X	MOHS-Micrographic Surgery Physician	27119	OK
3	207ND0101X	MOHS-Micrographic Surgery Physician	62088-20	WI
4	207R00000X	Internal Medicine Physician	27119	OK

General Provider Information

NPI Number	:	1043445620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AELAYNA MEYER MD

Provider Business Mailing Address
First Line	:	1145 S UTICA AVE STE 110
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4013
Country	:	US
Telephone Number	:	918-579-3825
Fax Number	:	918-579-1262

Provider Business Practice Location Address
First Line	:	9245 S MINGO RD
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5793
Country	:	US
Telephone Number	:	918-492-8980
Fax Number	:	918-495-0607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	08/15/2022

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