Healthcare Provider Details

I. General information

NPI: 1528061603
Provider Name (Legal Business Name): CLINTON SCOTT ANTHONY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 S OLYMPIA AVE SUITE 100
TULSA OK
74132-1823
US

IV. Provider business mailing address

6802 S OLYMPIA AVE SUITE 100
TULSA OK
74132-1823
US

V. Phone/Fax

Practice location:
  • Phone: 918-447-9300
  • Fax: 918-447-9308
Mailing address:
  • Phone: 918-447-9300
  • Fax: 918-447-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2940
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: