Provider Demographics
NPI:1053371435
Name:WESTCOTT, ROBERT M (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:WESTCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052-6448
Mailing Address - Country:US
Mailing Address - Phone:405-756-1240
Mailing Address - Fax:405-756-1243
Practice Address - Street 1:409 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052-6448
Practice Address - Country:US
Practice Address - Phone:405-756-1240
Practice Address - Fax:405-756-1243
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100167810DMedicaid
OKF95299Medicare UPIN