Healthcare Provider Details

I. General information

NPI: 1053551234
Provider Name (Legal Business Name): SCOTT A NEWBROUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S WHEELING AVE STE 100
TULSA OK
74104
US

IV. Provider business mailing address

2000 S WHEELING AVE STE 100
TULSA OK
74104-5643
US

V. Phone/Fax

Practice location:
  • Phone: 918-403-7070
  • Fax: 918-403-6327
Mailing address:
  • Phone: 918-403-7070
  • Fax: 918-403-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number26809
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number26809
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: