Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | G73573 | CA |
Y | 213ES0000X | Sports Medicine | G73573 | CA |
NPI | 1154433704 |
---|---|
Provider Name | Robert E Scott JR. |
First Address | San Diego, CA 92120-5256 |
Second Address | San Diego, CA 92120-5256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 20/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CB284785 | (05) | CA |
F87749 | (02) | CA |