Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 4297 | TX |
NPI | 1215091244 |
---|---|
Provider Name | Dr. Charles Anthony Scott |
First Address | Odessa, TX 79761-3029 |
Second Address | Odessa, TX 79761-3029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/07/2007 |