Basic Information
| Provider Information | |||||||||
| NPI: | 1346406899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4221 S WESTERN AVE | ||||||||
| Address2: | STE 4010 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056446464 | ||||||||
| FaxNumber: | 4056446465 | ||||||||
| Practice Location | |||||||||
| Address1: | 4221 S WESTERN AVE | ||||||||
| Address2: | STE 4010 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056446464 | ||||||||
| FaxNumber: | 4056446465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 02/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125-054055 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 5509 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.