Individual
ROBERT CLAYTON SCANLON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
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
Update your record
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