Healthcare Provider Details

I. General information

NPI: 1689809824
Provider Name (Legal Business Name): SCOTT NEWBROUGH MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 S BOULEVARD ST SUITE 110
EDMOND OK
73013-5478
US

IV. Provider business mailing address

3824 S BOULEVARD ST SUITE 110
EDMOND OK
73013-5478
US

V. Phone/Fax

Practice location:
  • Phone: 405-715-2227
  • Fax:
Mailing address:
  • Phone: 405-715-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number26809
License Number StateOK

VIII. Authorized Official

Name: DR. SCOTT ALAN NEWBROUGH
Title or Position: OWNER
Credential: M.D.
Phone: 405-715-2227