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General NPI Number Information
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NPI Number | 1225251820
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Entity Type | Individual
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Provider Name | ETHAN WALTER SCOTT M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 801 W MAPLE ST
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City | FARMINGTON
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State | NM
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Zip | 87401-5630
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Country | US
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Telephone | 505-609-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 5775 PASEO DEL RANCHO
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City | FARMINGTON
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State | NM
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Zip | 87402-3082
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Country | US
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Telephone | 210-834-5508
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | M-9833
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License Number State | ID
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