Healthcare Provider Details

I. General information

NPI: 1669646998
Provider Name (Legal Business Name): JOHN W SCOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE., SL79
NEW ORLEANS LA
70112
US

IV. Provider business mailing address

1430 TULANE AVE., SL79
NEW ORLEANS LA
70112
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5224
  • Fax: 504-988-7389
Mailing address:
  • Phone: 504-988-5224
  • Fax: 504-988-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License NumberMD.11107R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: