Provider Demographics
NPI:1689809824
Name:SCOTT NEWBROUGH MD PLLC
Entity Type:Organization
Organization Name:SCOTT NEWBROUGH MD PLLC
Other - Org Name:RESTORE PLASTIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NEWBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-715-2227
Mailing Address - Street 1:3824 S BOULEVARD ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5478
Mailing Address - Country:US
Mailing Address - Phone:405-715-2227
Mailing Address - Fax:
Practice Address - Street 1:3824 S BOULEVARD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5478
Practice Address - Country:US
Practice Address - Phone:405-715-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK268092086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty