Healthcare Provider Details

I. General information

NPI: 1215491337
Provider Name (Legal Business Name): SCOTT TYRUS WASHBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 N MICHIGAN AVE
GREENSBURG IN
47240-1487
US

IV. Provider business mailing address

2329 N BROADWAY ST APT 7
GREENSBURG IN
47240-6266
US

V. Phone/Fax

Practice location:
  • Phone: 812-222-3627
  • Fax:
Mailing address:
  • Phone: 812-209-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01094263A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: