Healthcare Provider Details

I. General information

NPI: 1043216823
Provider Name (Legal Business Name): SCOT B SCHEFFEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 UNIVERSITY DR
BOISE ID
83706
US

IV. Provider business mailing address

1188 W UNIVERSITY DR
BOISE ID
83706-3009
US

V. Phone/Fax

Practice location:
  • Phone: 208-336-8250
  • Fax: 208-345-9514
Mailing address:
  • Phone: 208-336-8250
  • Fax: 208-345-9514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberM7295
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: