Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 7179 | SC |
NPI | 1437105673 |
---|---|
Provider Name | John Russell Scott |
First Address | Spartanburg, SC 29307-1726 |
Second Address | Spartanburg, SC 29307-1726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 23/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
071790 | (05) | SC |
D97107 | (02) | SC |