Provider Demographics
NPI:1750822326
Name:SCOTT, JEROME
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-3610
Mailing Address - Country:US
Mailing Address - Phone:918-660-0255
Mailing Address - Fax:918-660-0267
Practice Address - Street 1:816 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3610
Practice Address - Country:US
Practice Address - Phone:918-660-0255
Practice Address - Fax:918-660-0267
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator