Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 50966 | MN |
N | 111NI0900X | Internist | 50966 | MN |
Y | 207RP1001X | Pulmonary Disease | 4301097324 | MI |
NPI | 1033309380 |
---|---|
Provider Name | Jacob P Scott |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49546-8292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 24/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033309380 | (05) | MI |
ENROLLED | (05) | MN |
P00746352 | MEDIICARE, RAILROAD (01) | MN |