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General NPI Number Information
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NPI Number | 1194357764
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Entity Type | Individual
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Provider Name | ROBERT SCOTT ANTHONY AGPCNP
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Gender | Male
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 201 NE SAVAGE ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-1309
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Country | US
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Telephone | 541-244-2197
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 NE 7TH ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-1319
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 202001314NP-PP
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License Number State | OR
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