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General NPI Number Information
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NPI Number | 1811044167
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Entity Type | Individual
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Provider Name | SCOTT M BOUTON MD
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 11000 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1714
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Country | US
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Telephone | 440-684-5829
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Fax | 440-449-1555
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Provider Business Mailing Address
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Address Line | 3605 WARRENSVILLE CENTER RD
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City | SHAKER HTS
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State | OH
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Zip | 44122-5203
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Country | US
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Telephone | 440-684-5829
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Fax | 440-449-1555
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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 | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 35-084734
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License Number State | OH
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