Healthcare Provider Details

I. General information

NPI: 1629068465
Provider Name (Legal Business Name): SCOT ALAN TEBO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BRULE ST
FORT KNOX KY
40121-6100
US

IV. Provider business mailing address

459 9TH CAVALRY REGIMENT AVE BLDG 503 RM 109
FORT KNOX KY
40121-5282
US

V. Phone/Fax

Practice location:
  • Phone: 502-624-3431
  • Fax:
Mailing address:
  • Phone: 520-855-5246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-13366
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD-13366
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: