MEDICARE: DIANE M SCOTT MD

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	ME82439	FL
2	207ND0900X	Dermatopathology Physician	ME82439	FL
3	207N00000X	Dermatology Physician	129874	CA
4	207ND0900X	Dermatopathology Physician	129874	CA

General Provider Information

NPI Number	:	1992786347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE M SCOTT MD

Provider Business Mailing Address
First Line	:	15611 POMERADO RD
Second Line	:	SUITE 400
City	:	POWAY
State	:	CA
Zip	:	92064-2437
Country	:	US
Telephone Number	:	858-675-3145
Fax Number	:	858-385-7855

Provider Business Practice Location Address
First Line	:	15611 POMERADO RD
Second Line	:	SUITE 400
City	:	POWAY
State	:	CA
Zip	:	92064-2437
Country	:	US
Telephone Number	:	858-675-3145
Fax Number	:	858-385-7855

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	08/13/2014

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