Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34605 | MO |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 34605 | MO |
NPI | 1184656076 |
---|---|
Provider Name | Kenneth F Scott JR. |
First Address | Clinton, MO 64735-3205 |
Second Address | Clinton, MO 64735-3205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 10/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C52058 | (02) |