Provider Demographics
NPI:1942749080
Name:EAR, NOSE, & THROAT, INC.
Entity Type:Organization
Organization Name:EAR, NOSE, & THROAT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORDRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-582-8217
Mailing Address - Street 1:2448 E 81ST ST
Mailing Address - Street 2:SUITE 1350
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4250
Mailing Address - Country:US
Mailing Address - Phone:918-582-8217
Mailing Address - Fax:918-582-8219
Practice Address - Street 1:2448 E 81ST ST
Practice Address - Street 2:SUITE 1350
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4250
Practice Address - Country:US
Practice Address - Phone:918-582-8217
Practice Address - Fax:918-582-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2947207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty