Individual
GREGORY NATHAN MELANCON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 S MAIN ST, MCALESTER, OK 74501-5303
(918) 423-5204
Mailing address
111 S MAIN ST, MCALESTER, OK 74501-5303
(918) 423-5204
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200305190B
—
OK
Enumeration date
02/18/2015
Last updated
02/18/2015
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