Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 3025 | OK |
NPI | 1306800362 |
---|---|
Provider Name | Dr. Scott Samuel Cyrus |
First Address | Tulsa, OK 74133-5726 |
Second Address | Tulsa, OK 74133-5726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 04/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100100600D | (05) | OK |
100733310A | (05) | OK |