Healthcare Provider Details

I. General information

NPI: 1245752211
Provider Name (Legal Business Name): JOSEPH EDWARD SCOTT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 WENTZVILLE PKWY
WENTZVILLE MO
63385-3695
US

IV. Provider business mailing address

633 EMERSON RD STE 100
CREVE COEUR MO
63141-6739
US

V. Phone/Fax

Practice location:
  • Phone: 314-866-8650
  • Fax: 314-991-2006
Mailing address:
  • Phone: 314-887-3548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006543
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2017022874
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2017022874
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: