Individual
DR. MELVIN J VANBOVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8803 S. 101ST E. AVE, SUITE 360, TULSA, OK 74133
(918) 582-0001
(918) 582-0003
Mailing address
PO BOX 26303, OKLAHOMA CITY, OK 73126-0303
(918) 582-0001
(918) 582-0003
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
1677
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100258170B
—
OK
01
—
223073900
DOL
—
05
—
24563544102
—
KS
Enumeration date
09/13/2006
Last updated
04/14/2020
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