MEDICARE: PALO BREA PAIN AND REHABILITATION

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	40645	AZ

General Provider Information

NPI Number	:	1457622789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALO BREA PAIN AND REHABILITATION

Provider Business Mailing Address
First Line	:	3417 N 32ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5606
Country	:	US
Telephone Number	:	602-368-3600
Fax Number	:	602-368-3235

Provider Business Practice Location Address
First Line	:	3417 N 32ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5606
Country	:	US
Telephone Number	:	602-368-3600
Fax Number	:	602-368-3235

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY DOUGLAS SCOTT
Credential	:	M.D.
Telephone Number	:	602-368-3600

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	01/18/2012

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Directions to “PALO BREA PAIN AND REHABILITATION ” Practice Location

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