Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | C-6467 | AR |
N | 208D00000X | General Practice Physician | C6467 | AR |
NPI | 1033368246 |
---|---|
Provider Name | Dr. Robert Brice Scott |
First Address | Dumas, AR 71639-0158 |
Second Address | Gould, AR 71643-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2008 |
Last Update Date | 17/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114525001 | (05) | AR |
C68311 | (02) | AR |