Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 19511 | OK |
NPI | 1285647586 |
---|---|
Provider Name | Scott William Meyers |
First Address | Tulsa, OK 74104-4626 |
Second Address | Tulsa, OK 74104-4626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 07/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G13541 | (02) |