MEDICARE: W SCOTT SERRILL, MD,PC

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	207N00000X	Dermatology Physician	OR10409	OR

General Provider Information

NPI Number	:	1336418748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W SCOTT SERRILL, MD,PC

Provider Business Mailing Address
First Line	:	1050 7TH AVE SW
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1924
Country	:	US
Telephone Number	:	541-928-1636
Fax Number	:	541-928-8770

Provider Business Practice Location Address
First Line	:	1050 7TH AVE SW
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1924
Country	:	US
Telephone Number	:	541-928-1636
Fax Number	:	541-928-8770

Authorized Official
Title or Position	:	MD/OWNER
Name	:	DR. W SCOTT SERRILL
Credential	:	M.D.
Telephone Number	:	541-928-1636

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	05/01/2012

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