=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467751404
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES A SCOTT MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2011
-----------------------------------------------------
Last Update Date | 03/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 PENNSYLVANIA AVE
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-250-5690
-----------------------------------------------------
Fax | 817-250-5695
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1325 PENNSYLVANIA AVE
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-250-5690
-----------------------------------------------------
Fax | 817-250-5695
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JAMES ALAN SCOTT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 817-250-5690
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | G9533
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------