Provider Demographics
NPI:1225397797
Name:KREITZBERG, SCOTT A (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:KREITZBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 S 101ST EAST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4562
Mailing Address - Country:US
Mailing Address - Phone:918-940-4700
Mailing Address - Fax:
Practice Address - Street 1:8010 S 101ST EAST AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4562
Practice Address - Country:US
Practice Address - Phone:918-940-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315085034208600000X
MI5101019676208600000X
OK68312086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery