MEDICARE: DR. MICHAEL DAVID SCOTT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G72438	CA

General Provider Information

NPI Number	:	1255351219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DAVID SCOTT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 451101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-8510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7601 IMPERIAL HWY
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90242-3456
Country	:	US
Telephone Number	:	562-401-6074
Fax Number	:	562-401-6074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	06/10/2011

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