Provider Demographics
NPI:1306800362
Name:CYRUS, SCOTT SAMUEL (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:SAMUEL
Last Name:CYRUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5726
Mailing Address - Country:US
Mailing Address - Phone:918-307-2273
Mailing Address - Fax:918-307-0273
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:STE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-307-2273
Practice Address - Fax:918-307-0273
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK30252080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100733310AMedicaid
OK100100600DMedicaid