Provider Demographics
NPI:1457391260
Name:BURROWS, ROSCOE GORDON II (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSCOE
Middle Name:GORDON
Last Name:BURROWS
Suffix:II
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 S 79TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1343
Mailing Address - Country:US
Mailing Address - Phone:918-720-7046
Mailing Address - Fax:
Practice Address - Street 1:3219 S 79TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1343
Practice Address - Country:US
Practice Address - Phone:918-720-7046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK939103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK233711301Medicare PIN