Provider Demographics
NPI:1982693396
Name:CORDRAY, SCOTT A (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:CORDRAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPT 262
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-582-8217
Mailing Address - Fax:918-582-8219
Practice Address - Street 1:2448 E 81ST ST
Practice Address - Street 2:STE 1350
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4248
Practice Address - Country:US
Practice Address - Phone:918-582-8217
Practice Address - Fax:918-582-8219
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK2947207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100249830BMedicaid
OK248427906Medicare ID - Type Unspecified
OK100249830BMedicaid