MEDICARE: DR. PAUL D 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	208600000X	Surgery Physician	PENDING	WI
2	208600000X	Surgery Physician	53182	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55594	OTHER	WI	WISCONSIN STATE LICENSE

General Provider Information

NPI Number	:	1336127042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL D SCOTT M.D.

Provider Business Mailing Address
First Line	:	2925 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1321
Country	:	US
Telephone Number	:	612-262-1166
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 SMITH AVE N
Second Line	:	#700
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-2424
Country	:	US
Telephone Number	:	651-241-7000
Fax Number	:	651-241-8778

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	11/10/2020

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Directions to “ DR. PAUL D SCOTT M.D.” Practice Location

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