=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841359189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VINCENT FRANK SCOCCIA D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 03/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 707 HILL COUNTRY DR SUITE 106
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78028-5996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-896-0404
-----------------------------------------------------
Fax | 830-896-4343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 294898
-----------------------------------------------------
City | KERRVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78029-4898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-482-4077
-----------------------------------------------------
Fax | 830-896-4343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 869
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | M5995
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------