Healthcare Provider Details

I. General information

NPI: 1508210337
Provider Name (Legal Business Name): SCOTT DOUGLAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE STE A28
CINCINNATI OH
45219
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2610
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-2472
  • Fax: 513-585-4094
Mailing address:
  • Phone: 513-351-9900
  • Fax: 513-366-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.136240
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: