Healthcare Provider Details

I. General information

NPI: 1336176858
Provider Name (Legal Business Name): TIMOTHY J SCOTT DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22905 ROUTE 68
CLARION PA
16214-8557
US

IV. Provider business mailing address

22905 ROUTE 68
CLARION PA
16214-8557
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-0717
  • Fax: 814-226-5336
Mailing address:
  • Phone: 814-226-0717
  • Fax: 814-226-5336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC004077L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC004077L
License Number StatePA

VIII. Authorized Official

Name: DR. TIMOTHY J SCOTT
Title or Position: DOCTOR
Credential: DPM
Phone: 814-226-0717