MEDICARE: DR. RIDDELL WALCOTT 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	207N00000X	Dermatology Physician	58454	MN
2	207N00000X	Dermatology Physician	40557	TN
3	207NP0225X	Pediatric Dermatology Physician	40557	TN
4	207NS0135X	Procedural Dermatology Physician	40557	TN
5	207N00000X	Dermatology Physician	T8340	TX

General Provider Information

NPI Number	:	1881708139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RIDDELL WALCOTT SCOTT M.D.

Provider Business Mailing Address
First Line	:	4419 FRONTIER TRL STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1567
Country	:	US
Telephone Number	:	512-444-7208
Fax Number	:	512-444-2343

Provider Business Practice Location Address
First Line	:	4419 FRONTIER TRL STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1567
Country	:	US
Telephone Number	:	512-444-7208
Fax Number	:	512-444-2343

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	11/30/2023

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