Provider Demographics
NPI:1508839812
Name:CORDRAY, SCOT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:ALAN
Last Name:CORDRAY
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:
Practice Address - Street 1:110 NW 3ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6100
Practice Address - Country:US
Practice Address - Phone:580-357-3671
Practice Address - Fax:580-357-1256
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5108207X00000X, 207XS0114X, 207XX0005X, 207XX0801X
IN01081953A207X00000X
OK26784207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G8109OtherBCBS
104259Medicare UPIN
TXP00397071Medicare PIN
8J3363Medicare PIN
TX8G8109OtherBCBS