Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | R76154 | AZ |
NPI | 1013445410 |
---|---|
Provider Name | Gabriel Rene Scott |
First Address | Tucson, AZ 85711-1848 |
Second Address | Tucson, AZ 85724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2017 |
Last Update Date | 03/07/2018 |