=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417067455
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT R PRICE DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 02/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3149 N WINDSONG DR
-----------------------------------------------------
City | PRESCOTT VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86314-2240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-772-5916
-----------------------------------------------------
Fax | 928-775-3250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3149 N WINDSONG DR
-----------------------------------------------------
City | PRESCOTT VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86314-2240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-710-5014
-----------------------------------------------------
Fax | 928-775-3250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 0564
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------