MEDICARE: SCOT BURROUGHS PA

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	363A00000X	Physician Assistant	001366	IA

General Provider Information

NPI Number	:	1467420729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOT BURROUGHS PA

Provider Business Mailing Address
First Line	:	3329 SHAMROCK DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-5133
Country	:	US
Telephone Number	:	319-321-1788
Fax Number	:

Provider Business Practice Location Address
First Line	:	3329 SHAMROCK DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-5133
Country	:	US
Telephone Number	:	319-321-1788
Fax Number	:

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/08/2007

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Directions to “ SCOT BURROUGHS PA” Practice Location

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