Healthcare Provider Details

I. General information

NPI: 1750878286
Provider Name (Legal Business Name): WARREN EDWARD SCOTT JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HOSPITAL DR
MOUNTAIN HOME AR
72653-2955
US

IV. Provider business mailing address

860 HIGHWAY 62 E STE 10
MOUNTAIN HOME AR
72653-3200
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-3181
  • Fax: 870-424-3089
Mailing address:
  • Phone: 870-424-3181
  • Fax: 870-424-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberE-12602
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: