MEDICARE: DR. SCOTT A PAXTON D.O.

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	207Q00000X	Family Medicine Physician	5101013909	MI
2	207Q00000X	Family Medicine Physician	1800	WI
3	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	1800	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0858207125	OTHER	MI	BCBS INDIVIDUAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	700H219150	OTHER	MI	BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1800	OTHER	WI	STATE LICENSE

General Provider Information

NPI Number	:	1548246242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT A PAXTON D.O.

Provider Business Mailing Address
First Line	:	W2850 STATE ROAD 28
Second Line	:
City	:	SHEBOYGAN FALLS
State	:	WI
Zip	:	53085-2702
Country	:	US
Telephone Number	:	920-467-1800
Fax Number	:	920-467-1900

Provider Business Practice Location Address
First Line	:	W2850 STATE ROAD 28
Second Line	:
City	:	SHEBOYGAN FALLS
State	:	WI
Zip	:	53085-2702
Country	:	US
Telephone Number	:	920-467-1800
Fax Number	:	920-467-1900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	01/03/2025

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Directions to “ DR. SCOTT A PAXTON D.O.” Practice Location

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