Provider Demographics
NPI:1386672392
Name:MUSICK, SCOTT RANDALL (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RANDALL
Last Name:MUSICK
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 1:1102 NW LOWE'S AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712
Mailing Address - Country:US
Mailing Address - Phone:479-254-8563
Mailing Address - Fax:479-254-8564
Practice Address - Street 1:1102 NW LOWE'S AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-254-8563
Practice Address - Fax:479-254-8564
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4104207Q00000X
ARE5005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I05317Medicare UPIN
244517409Medicare ID - Type Unspecified