Healthcare Provider Details

I. General information

NPI: 1477735801
Provider Name (Legal Business Name): LARRY SCORTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5066 N FRESNO ST STE 101
FRESNO CA
93710-7615
US

IV. Provider business mailing address

5066 N FRESNO ST STE 101
FRESNO CA
93710-7615
US

V. Phone/Fax

Practice location:
  • Phone: 559-206-5688
  • Fax: 559-283-8440
Mailing address:
  • Phone: 559-206-5688
  • Fax: 559-283-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE26290
License Number StateCA

VIII. Authorized Official

Name: LARRY D SCORTT
Title or Position: OWNER
Credential: DPM
Phone: 559-206-5688