Healthcare Provider Details

I. General information

NPI: 1982693396
Provider Name (Legal Business Name): SCOTT A CORDRAY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 E 81ST ST STE 1350
TULSA OK
74137-4248
US

IV. Provider business mailing address

PO BOX 21228 DEPT 262
TULSA OK
74121-1228
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-8217
  • Fax: 918-582-8219
Mailing address:
  • Phone: 918-582-8217
  • Fax: 918-582-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2947
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: