Provider Demographics
NPI:1487893442
Name:SCOTT, PAUL (RT (R))
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73534-0188
Mailing Address - Country:US
Mailing Address - Phone:580-475-9729
Mailing Address - Fax:580-475-9728
Practice Address - Street 1:944 W WILLOW AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4922
Practice Address - Country:US
Practice Address - Phone:580-475-9729
Practice Address - Fax:580-475-9728
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237277247100000X
OK237277247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200043590AMedicaid
OK200043590AMedicaid