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General NPI Number Information
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NPI Number | 1467691535
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Entity Type | Organization
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Legal Business Name | SCARLETT CUSTER DO PC
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 8734 N 4003 DR BOX 309
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City | COPAN
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State | OK
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Zip | 74022-0309
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Country | US
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Telephone | 918-214-4068
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 309
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City | COPAN
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State | OK
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Zip | 74022-0309
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Country | US
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Telephone | 918-214-4068
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SCARLETT FLORENCE CUSTER
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Credential | D.O.
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Telephone | 918-214-4068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3401
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License Number State | OK
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