Healthcare Provider Details

I. General information

NPI: 1164666434
Provider Name (Legal Business Name): SCOTT CRAIG DILLARD MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 LEE ROAD 426
SMITHS AL
36877-3227
US

IV. Provider business mailing address

770 LEE ROAD 426
SMITHS AL
36877-3227
US

V. Phone/Fax

Practice location:
  • Phone: 706-341-6808
  • Fax:
Mailing address:
  • Phone: 706-341-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberMD30458
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberMD30458
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: