Healthcare Provider Details

I. General information

NPI: 1245433036
Provider Name (Legal Business Name): SCOTT JOHN DEERING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 S SHOOP AVE
WAUSEON OH
43567-1735
US

IV. Provider business mailing address

735 S SHOOP AVE
WAUSEON OH
43567-1735
US

V. Phone/Fax

Practice location:
  • Phone: 419-335-2663
  • Fax: 419-335-9615
Mailing address:
  • Phone: 419-335-2663
  • Fax: 419-335-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301085624
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301085624
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number096995
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: