Healthcare Provider Details

I. General information

NPI: 1912526450
Provider Name (Legal Business Name): MICHAEL TIMOTHY SCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR # S287
STANFORD CA
94305-2200
US

IV. Provider business mailing address

300 PASTEUR DR # S287
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-5746
  • Fax:
Mailing address:
  • Phone: 650-725-5746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number344025
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: