Individual
ROBERT CLAYTON SCANLON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3000
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3000
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
R5F54
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10028
BC/BS PROVIDER ID
MO
05
—
1013915792
—
MO
01
—
19-40002
UHC PROVIDER ID
MO
01
—
2075
GATEWAY EDI SUBMITTER ID
MO
05
—
242280501
—
MO
01
—
333950115
MEDICARE PIN OCH
—
01
—
340006342
PALMETTO GBA-MRR ID
—
01
—
P00364221
MEDICARE RR OCH
—
Enumeration date
07/07/2005
Last updated
06/30/2014
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