Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | R5F54 | MO |
NPI | 1013915792 |
---|---|
Provider Name | Robert Clayton Scanlon II |
First Address | Springfield, MO 65808-9007 |
Second Address | Springfield, MO 65807-5155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 30/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10028 | BC/BS PROVIDER ID (01) | MO |
1013915792 | (05) | MO |
19-40002 | UHC PROVIDER ID (01) | MO |
2075 | GATEWAY EDI SUBMITTER ID (01) | MO |
242280501 | (05) | MO |
333950115 | MEDICARE PIN OCH (01) | |
340006342 | PALMETTO GBA-MRR ID (01) | |
A10693 | (02) | |
P00364221 | MEDICARE RR OCH (01) |