Healthcare Provider Details

I. General information

NPI: 1497040513
Provider Name (Legal Business Name): PATRICK LLOYD SCARBOROUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

2159 ISLAND SHORE WAY
SAN MARCOS CA
92078-5482
US

V. Phone/Fax

Practice location:
  • Phone: 801-380-4986
  • Fax:
Mailing address:
  • Phone: 801-380-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA122225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: