Healthcare Provider Details

I. General information

NPI: 1730165374
Provider Name (Legal Business Name): DAVID SCOTT INNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

IV. Provider business mailing address

240 HOSPITAL PL STE 204
SOLDOTNA AK
99669-7559
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4130
  • Fax: 907-262-7735
Mailing address:
  • Phone: 907-262-1080
  • Fax: 877-735-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5710
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: