Healthcare Provider Details

I. General information

NPI: 1932274412
Provider Name (Legal Business Name): SHIRLEY B SCOTT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 LUISA PLACE
SANTA FE NM
87505
US

IV. Provider business mailing address

PO BOX 2670
SANTA FE NM
87504
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-9960
  • Fax: 505-988-1550
Mailing address:
  • Phone: 505-986-9960
  • Fax: 505-988-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA034359
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberNM8995
License Number StateNM

VIII. Authorized Official

Name: DR. SHIRLEY B SCOTT
Title or Position: PRESIDENT
Credential: MD
Phone: 505-986-9960