MEDICARE: ROBERT CLAYTON SCANLON II D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	R5F54	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	333950115	OTHER		MEDICARE PIN OCH
6	P00364221	OTHER		MEDICARE RR OCH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19-40002	OTHER	MO	UHC PROVIDER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2075	OTHER	MO	GATEWAY EDI SUBMITTER ID
5	340006342	OTHER		PALMETTO GBA-MRR ID
7	10028	OTHER	MO	BC/BS PROVIDER ID
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013915792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CLAYTON SCANLON II D.O.

Provider Business Mailing Address
First Line	:	PO BOX 9007
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65808-9007
Country	:	US
Telephone Number	:	417-875-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 E PRIMROSE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5155
Country	:	US
Telephone Number	:	417-875-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/30/2014

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