Healthcare Provider Details

I. General information

NPI: 1629064639
Provider Name (Legal Business Name): DOUGLAS R SCOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 HOUNSELL AVE
GILFORD NH
03249-6922
US

IV. Provider business mailing address

PO BOX 7625
GILFORD NH
03247-7625
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-2020
  • Fax: 603-528-2805
Mailing address:
  • Phone: 603-524-2020
  • Fax: 603-528-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number8400
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number8400
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: