Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | G52014 | CA |
NPI | 1033144373 |
---|---|
Provider Name | Dr. Warren Alan Scott |
First Address | Soquel, CA 95073-2560 |
Second Address | Soquel, CA 95073-2560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F10726 | (02) |