Individual
MELINDA ROTHER ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
100 ELMWOOD AVE, PONCA CITY, OK 74601-3406
(580) 716-1778
(918) 787-2276
Mailing address
100 ELMWOOD AVE, PONCA CITY, OK 74601-3406
(580) 716-1778
(918) 787-2276
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3741
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001360403
—
OK
01
—
110245910
RR MEDICARE
—
Enumeration date
08/19/2005
Last updated
03/09/2015
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