Provider Demographics
NPI:1861422875
Name:DYCUS, D. SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:D. SCOTT
Middle Name:
Last Name:DYCUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SW 155TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-9308
Mailing Address - Country:US
Mailing Address - Phone:405-794-6683
Mailing Address - Fax:405-793-8703
Practice Address - Street 1:320 N SERVICE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73160-4945
Practice Address - Country:US
Practice Address - Phone:405-794-4474
Practice Address - Fax:405-793-8703
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD38535Medicare UPIN