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General NPI Number Information
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NPI Number | 1316013931
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Entity Type | Organization
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Legal Business Name | DIAMOND BAR EAR NOSE & THROAT SPECIALTY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 1111 GRAND AVE., SUITE E
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City | DIAMOND BAR
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State | CA
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Zip | 91765-2227
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Country | US
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Telephone | 909-860-7712
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Fax | 909-861-1311
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Provider Business Mailing Address
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Address Line | 1111 GRAND AVE., SUITE E
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City | DIAMOND BAR
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State | CA
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Zip | 91765-2227
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Country | US
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Telephone | 909-860-7712
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Fax | 909-861-1311
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TERRY WESLEY SCOTT SR.
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Credential | M.D.
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Telephone | 909-860-7712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | G54536
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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