Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 1905 | OK |
N | 208200000X | Surgeon | 1905 | OK |
N | 208600000X | Surgeon | 1905 | OK |
NPI | 1003897760 |
---|---|
Provider Name | Dr. Michael B Scott |
First Address | Enid, OK 73701-6156 |
Second Address | Enid, OK 73701-6156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0562484067 | (05) | OK |
E16004 | (02) |