Provider Demographics
NPI:1245399138
Name:SCOTT, MICHAEL GREG (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GREG
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 S. PEORIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-3825
Mailing Address - Country:US
Mailing Address - Phone:918-588-1900
Mailing Address - Fax:918-582-6405
Practice Address - Street 1:550 S. PEORIA AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3825
Practice Address - Country:US
Practice Address - Phone:918-588-1900
Practice Address - Fax:918-582-6405
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732910-GOtherGROUP MEDICAID/SOONERCARE
OK73-1042545OtherGROUP MEDICARE
OK73-1042545OtherGROUP BCBS
OK100199580AMedicaid
OK73-1042545OtherGROUP COMMUNITY CARE OF OKLAHOMA
OK100732910-AOtherGROUP MEDICAID/SOONERCARE
OK731042545001OtherGROUP TRICARE
OK1118422Medicaid
OK73-1042545OtherGROUP MEDICARE
OKG19876Medicare UPIN