Healthcare Provider Details

I. General information

NPI: 1033615620
Provider Name (Legal Business Name): SCOTT LAURENZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LAUREL ST STE A120
DES MOINES IA
50314-3027
US

IV. Provider business mailing address

PO BOX 674721
DALLAS TX
75267-4721
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-7900
  • Fax: 515-643-7901
Mailing address:
  • Phone: 515-643-7900
  • Fax: 515-643-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.160042
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number72386-20
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD-54739
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: