MEDICARE: MELISSA ANN LOFTIS PAC

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	PA745	OK

General Provider Information

NPI Number	:	1619959814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANN LOFTIS PAC

Provider Business Mailing Address
First Line	:	7301 N COMANCHE AVE
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73132-6636
Country	:	US
Telephone Number	:	405-728-2100
Fax Number	:	405-728-2244

Provider Business Practice Location Address
First Line	:	7301 N COMANCHE AVE
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73132-6636
Country	:	US
Telephone Number	:	405-728-2100
Fax Number	:	405-728-2244

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	02/03/2011

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Directions to “ MELISSA ANN LOFTIS PAC” Practice Location

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