Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DE00008870 | WA |
N | 1223D0001X | Dental Public Health | DE00008870 | WA |
Y | 1223G0001X | General Practice | DE00008870 | WA |
Y | 213EG0000X | General Practice | DE00008870 | WA |
NPI | 1497704571 |
---|---|
Provider Name | Dr. Scott John Rankin |
First Address | Ft Gordon, GA 30905-5660 |
Second Address | Ft Gordon, GA 30905-5660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 31/01/2019 |