Provider Demographics
NPI:1700014271
Name:STREET, SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:STREET
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 1:1010 N. KANSAS
Mailing Address - Street 2:WCGME
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214
Mailing Address - Country:US
Mailing Address - Phone:316-962-3030
Mailing Address - Fax:
Practice Address - Street 1:817 S ELM PL STE 106
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5369
Practice Address - Country:US
Practice Address - Phone:918-928-5437
Practice Address - Fax:888-720-8944
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7212207Q00000X
OK5821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine