MEDICARE: EDWARD G SCATES DPM 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	213E00000X	Podiatrist	0326	AZ

General Provider Information

NPI Number	:	1417221623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD G SCATES DPM PC

Provider Business Mailing Address
First Line	:	3832 E. THOMAS ROAD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7510
Country	:	US
Telephone Number	:	602-955-4515
Fax Number	:	602-955-7096

Provider Business Practice Location Address
First Line	:	3832 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7510
Country	:	US
Telephone Number	:	602-955-4515
Fax Number	:	602-955-7096

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD G. SCATES
Credential	:	DPM
Telephone Number	:	602-955-4515

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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