Provider Demographics
NPI:1932148673
Name:SCOTT, LARRY BRENT (DO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:BRENT
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:UNKNOWN
Other - Middle Name:BRENT
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3033 NW 63RD ST
Mailing Address - Street 2:SUITE 152
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3634
Mailing Address - Country:US
Mailing Address - Phone:405-755-6651
Mailing Address - Fax:405-607-3559
Practice Address - Street 1:13401 N WESTERN AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1407
Practice Address - Country:US
Practice Address - Phone:405-608-4440
Practice Address - Fax:405-608-4441
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4165207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200028810AMedicaid
OKI0541Medicare UPIN
I05415Medicare UPIN
243416800Medicare PIN
OK300522082Medicare ID - Type Unspecified