MEDICARE: DR. MARY MELISSA MORGAN M.D.

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	207NS0135X	Procedural Dermatology Physician	20128	OK

General Provider Information

NPI Number	:	1487621413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY MELISSA MORGAN M.D.

Provider Business Mailing Address
First Line	:	6200 W UTICA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74011-1115
Country	:	US
Telephone Number	:	918-629-9889
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 S ASPEN AVE STE A
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7501
Country	:	US
Telephone Number	:	918-770-4599
Fax Number	:	918-770-7060

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	08/01/2025

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