Provider Demographics
NPI:1487621413
Name:MORGAN, MARY MELISSA (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:MELISSA
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1621 S EUCALYPTUS AVE
Mailing Address - Street 2:SUTIE 202
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5940
Mailing Address - Country:US
Mailing Address - Phone:918-459-7546
Mailing Address - Fax:918-459-7575
Practice Address - Street 1:1621 S EUCALYPTUS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5940
Practice Address - Country:US
Practice Address - Phone:918-459-7546
Practice Address - Fax:918-459-7575
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-05-08
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Provider Licenses
StateLicense IDTaxonomies
OK20128207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG49177Medicare UPIN