Healthcare Provider Details

I. General information

NPI: 1477960748
Provider Name (Legal Business Name): IAN SCOTT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5071
APO AP
96328-5071
US

IV. Provider business mailing address

UNIT 5071
APO AP
96328-5071
US

V. Phone/Fax

Practice location:
  • Phone: 315-225-3575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0005666
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: