=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114263530
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN LEA SCOTT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2012
-----------------------------------------------------
Last Update Date | 09/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 EUREKA ST STE B
-----------------------------------------------------
City | WEATHERFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76086-6521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-893-5637
-----------------------------------------------------
Fax | 817-666-3873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2340 E TRINITY MILLS RD STE 250
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-1946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-417-8937
-----------------------------------------------------
Fax | 972-439-1977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | J2317
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------