Provider Demographics
NPI:1952305849
Name:MITCHELL, SCOTT A (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:MITCHELL
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 1:3601 NW 138TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2507
Mailing Address - Country:US
Mailing Address - Phone:405-775-9350
Mailing Address - Fax:405-775-9360
Practice Address - Street 1:3601 NW 138TH ST
Practice Address - Street 2:STE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-2507
Practice Address - Country:US
Practice Address - Phone:405-775-9350
Practice Address - Fax:405-775-9360
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2802208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100124110AMedicaid
OK050074315OtherMEDICARE RR
OK100124110BMedicaid
OKP00452075OtherMEDICARE RR
OK050074315OtherMEDICARE RR
OK$$$$$$$$$004OtherBC/BS
OK050074315OtherMEDICARE RR
OK100124110AMedicaid
OK100124110BMedicaid