Healthcare Provider Details

I. General information

NPI: 1609806348
Provider Name (Legal Business Name): RICHARD ALLEN SCOTT JR. DC, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 W 24TH ST
YUMA AZ
85364-6123
US

IV. Provider business mailing address

PO BOX 617
SOMERTON AZ
85350-0617
US

V. Phone/Fax

Practice location:
  • Phone: 928-819-8999
  • Fax:
Mailing address:
  • Phone: 928-236-8001
  • Fax: 928-722-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8186
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: