Healthcare Provider Details

I. General information

NPI: 1669695516
Provider Name (Legal Business Name): WILLIAM J SCOTT D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10325 DEWHURST RD
ELYRIA OH
44035-8403
US

IV. Provider business mailing address

6200 PLEASANT AVE SUITE 3
FAIRFIELD OH
45014-4670
US

V. Phone/Fax

Practice location:
  • Phone: 440-973-8199
  • Fax:
Mailing address:
  • Phone: 513-829-9333
  • Fax: 513-858-7827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-003494
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: