MEDICARE: MELODY J YOZZO PA C

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	363A00000X	Physician Assistant	1349	OK

General Provider Information

NPI Number	:	1164414132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY J YOZZO PA C

Provider Business Mailing Address
First Line	:	PO BOX 268838
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-8838
Country	:	US
Telephone Number	:	918-660-3614
Fax Number	:	918-660-3611

Provider Business Practice Location Address
First Line	:	4502 E 41ST ST
Second Line	:	STE 2G12
City	:	TULSA
State	:	OK
Zip	:	74135-2512
Country	:	US
Telephone Number	:	918-660-3614
Fax Number	:	918-660-3611

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	03/03/2008

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