Healthcare Provider Details

I. General information

NPI: 1023396520
Provider Name (Legal Business Name): SCOTT WALEN M.D., FRCSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

825 NE 10TH ST
OKLAHOMA CITY OK
73104-5417
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-1368
  • Fax:
Mailing address:
  • Phone: 405-271-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD472150
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD472150
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number46564
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number2011009936
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: