=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689682072
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT P FIELDER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2006
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 NEWPORT BLVD
-----------------------------------------------------
City | LA PORTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46350-4099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-326-2663
-----------------------------------------------------
Fax | 219-326-1951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 NEWPORT BLVD
-----------------------------------------------------
City | LA PORTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46350-4099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-326-2663
-----------------------------------------------------
Fax | 219-326-1951
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 01050802
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------