Provider Demographics
NPI:1912909672
Name:WILLIAMS, SCOTT A (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-1009
Mailing Address - Country:US
Mailing Address - Phone:580-303-9293
Mailing Address - Fax:580-540-3017
Practice Address - Street 1:411 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5201
Practice Address - Country:US
Practice Address - Phone:580-303-9293
Practice Address - Fax:580-540-3017
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG95780Medicare UPIN
OK245735301Medicare PIN