Provider Demographics
NPI:1003897760
Name:SCOTT, MICHAEL B (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:915 E GARRIOTT RD
Mailing Address - Street 2:STE B
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-6156
Mailing Address - Country:US
Mailing Address - Phone:580-233-5544
Mailing Address - Fax:580-233-7895
Practice Address - Street 1:915 E GARRIOTT RD
Practice Address - Street 2:STE B
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6156
Practice Address - Country:US
Practice Address - Phone:580-233-5544
Practice Address - Fax:580-233-7895
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1905207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0562484067Medicaid
E16004Medicare UPIN