Healthcare Provider Details

I. General information

NPI: 1902820467
Provider Name (Legal Business Name): SCOTT A BARRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE LOVELACE MEDICAL CENTER
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

PO BOX 4934
ALBUQUERQUE NM
87196-4934
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-0301
  • Fax:
Mailing address:
  • Phone: 505-298-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA6-171
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberA6-171
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number86171
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: