MEDICARE: DR. SCOTT JEROME ZUCKERMAN 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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	4956100-1205	UT

General Provider Information

NPI Number	:	1538498704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT JEROME ZUCKERMAN M.D.

Provider Business Mailing Address
First Line	:	7381 BUCKBOARD DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5310
Country	:	US
Telephone Number	:	435-901-0057
Fax Number	:

Provider Business Practice Location Address
First Line	:	7381 BUCKBOARD DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5310
Country	:	US
Telephone Number	:	435-901-0057
Fax Number	:

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

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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