MEDICARE: LUCAS MEYERS 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	207L00000X	Anesthesiology Physician	6029	OK
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1205218047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS MEYERS D.O.

Provider Business Mailing Address
First Line	:	1523 S NORFOLK AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-6221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 W 17TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74107-1886
Country	:	US
Telephone Number	:	918-704-7630
Fax Number	:

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

Provider Enumeration Date	:	06/28/2015
Last Update Date	:	11/29/2023

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Directions to “ LUCAS MEYERS D.O.” Practice Location

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