Provider Demographics
NPI:1699964932
Name:SCOTT C ROBERTSON MD PC
Entity type:Organization
Organization Name:SCOTT C ROBERTSON MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-737-0203
Mailing Address - Street 1:9060 HARMONY DR
Mailing Address - Street 2:STE E
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6218
Mailing Address - Country:US
Mailing Address - Phone:405-737-0203
Mailing Address - Fax:405-737-0221
Practice Address - Street 1:9060 HARMONY DR
Practice Address - Street 2:STE E
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6218
Practice Address - Country:US
Practice Address - Phone:405-737-0203
Practice Address - Fax:405-737-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20580207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522070Medicare PIN