MEDICARE: SCOTT RANDALL BINGHAM

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	363LF0000X	Family Nurse Practitioner	327532	AZ

General Provider Information

NPI Number	:	1790648384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT RANDALL BINGHAM

Provider Business Mailing Address
First Line	:	525 N DATE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-5637
Country	:	US
Telephone Number	:	480-625-4538
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 E BROWN RD STE 28
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-4217
Country	:	US
Telephone Number	:	480-625-4538
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ SCOTT RANDALL BINGHAM ” Practice Location

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