Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 887-025 | WI |
Y | 222Z00000X | Podiatrist | 887-025 | WI |
NPI | 1043319916 |
---|---|
Provider Name | Dr. David Bruce Scott |
First Address | Richmond, IN 47374-6645 |
Second Address | Buffalo Grove, IL 60089-1999 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 11/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000550791 | ANTHEM BCBS (01) | IN |
200878300 | (05) | IN |
43237000 | (05) | WI |
P00144281 | RAILROAD (01) | WI |
V01427 | (02) | WI |