Healthcare Provider Details

I. General information

NPI: 1275557662
Provider Name (Legal Business Name): JOHN R SCOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SENATE BLVD
INDIANAPOLIS IN
46202-1228
US

IV. Provider business mailing address

545 BARNHILL DR
INDIANAPOLIS IN
46202-5112
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-8800
  • Fax:
Mailing address:
  • Phone: 317-274-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01023989A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: