Healthcare Provider Details

I. General information

NPI: 1750360137
Provider Name (Legal Business Name): CLINTON HERWIN SCOTT JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W 5TH AVE
GARY IN
46402-1808
US

IV. Provider business mailing address

3903 PORTAGE RD SUITE C #161
SOUTH BEND IN
46628-4431
US

V. Phone/Fax

Practice location:
  • Phone: 609-440-8714
  • Fax: 269-469-9240
Mailing address:
  • Phone: 609-440-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000990A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: