Provider Demographics
NPI:1336218320
Name:CUSTER, SCARLETT FLORENCE (D O)
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:FLORENCE
Last Name:CUSTER
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2526
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2526
Mailing Address - Country:US
Mailing Address - Phone:417-347-7600
Mailing Address - Fax:417-347-9810
Practice Address - Street 1:2431 NOWATA PL
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-4708
Practice Address - Country:US
Practice Address - Phone:918-333-5521
Practice Address - Fax:918-333-7139
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG37508Medicare UPIN