Healthcare Provider Details

I. General information

NPI: 1205802386
Provider Name (Legal Business Name): SCOTT ALAN FUJIMOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BERGQUIST DR SUITE 1
LACKLAND A F B TX
78236-5300
US

IV. Provider business mailing address

3333 OAKWELL CT
SAN ANTONIO TX
78218-3015
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-6707
  • Fax:
Mailing address:
  • Phone: 210-832-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA76473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: