MEDICARE: JIM G MELTON D.O.

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	208600000X	Surgery Physician	3168	OK
2	2086S0129X	Vascular Surgery Physician	3168	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	770001792	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093702011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM G MELTON D.O.

Provider Business Mailing Address
First Line	:	3200 QUAIL SPRINGS PKWY
Second Line	:	STE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2612
Country	:	US
Telephone Number	:	405-701-9880
Fax Number	:	405-701-9881

Provider Business Practice Location Address
First Line	:	3200 QUAIL SPRINGS PKWY
Second Line	:	STE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2612
Country	:	US
Telephone Number	:	405-701-9880
Fax Number	:	405-701-9881

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	11/18/2015

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Directions to “ JIM G MELTON D.O.” Practice Location

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