Provider Demographics
NPI:1285647586
Name:MEYERS, SCOTT WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:WILLIAM
Last Name:MEYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4626
Mailing Address - Country:US
Mailing Address - Phone:918-293-9966
Mailing Address - Fax:918-293-9988
Practice Address - Street 1:1440 TERRACE DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4626
Practice Address - Country:US
Practice Address - Phone:918-293-9966
Practice Address - Fax:918-293-9988
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19511207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G13541Medicare UPIN