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Individual
JIM G MELTON
Active
Individual
JIM G MELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
3168
OK
2086S0129X
Vascular Surgery Physician
Primary
3168
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100130690A
—
OK
01
—
770001792
RAILROAD MEDICARE
OK
Enumeration date
10/04/2005
Last updated
11/18/2015
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