Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 036134025 | IL |
N | 207W00000X | Ophthalmologist | 248001 | NY |
N | 207W00000X | Ophthalmologist | MD60294408 | WA |
N | 2084N0400X | Neurologist | 248001 | NY |
N | 2084N0400X | Neurologist | MD60294408 | WA |
NPI | 1003872359 |
---|---|
Provider Name | Colin J Scott |
First Address | Peoria, IL 61615-7822 |
Second Address | Peoria, IL 61615-7822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 20/10/2021 |