Healthcare Provider Details

I. General information

NPI: 1417151044
Provider Name (Legal Business Name): JEFFREY SCOTT, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 N CARPENTER RD SUITE D-1
MODESTO CA
95351-1147
US

IV. Provider business mailing address

1521 N CARPENTER RD STE D1
MODESTO CA
95351-1217
US

V. Phone/Fax

Practice location:
  • Phone: 209-163-8230
  • Fax: 209-575-7515
Mailing address:
  • Phone: 209-575-7520
  • Fax: 209-575-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA80104
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY D SCOTT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-575-7520