Healthcare Provider Details

I. General information

NPI: 1497951719
Provider Name (Legal Business Name): SCOTT DOUGLASS PRATER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2007
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LEE AVE 4TH FLOOR
OKLAHOMA CITY OK
73102-1036
US

IV. Provider business mailing address

1000 N LEE AVE FL 4
OKLAHOMA CITY OK
73102-1036
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-7699
  • Fax: 405-272-6662
Mailing address:
  • Phone: 405-272-7699
  • Fax: 405-272-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number29732
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA12501800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberTPME7404
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA12501800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: