Provider Demographics
NPI:1659371920
Name:SCOTT, ROBERT BRENT (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRENT
Last Name:SCOTT
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 1:12324 E 86TH ST N STE 337
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2543
Mailing Address - Country:US
Mailing Address - Phone:303-695-8684
Mailing Address - Fax:
Practice Address - Street 1:105 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3439
Practice Address - Country:US
Practice Address - Phone:918-274-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0044016207Q00000X
OK3219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF96912Medicare UPIN