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General NPI Number Information
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NPI Number | 1881758217
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Entity Type | Individual
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Provider Name | SCOTT MATTOON PA
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 875 PRE EMPTION RD
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City | GENEVA
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State | NY
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Zip | 14456-2042
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Country | US
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Telephone | 315-462-2633
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Fax |
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Provider Business Mailing Address
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Address Line | 875 PRE EMPTION RD
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City | GENEVA
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State | NY
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Zip | 14456-2042
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0072521
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 007252
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License Number State | NY
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