Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0749 | AZ |
N | 222Z00000X | Podiatrist | 0749 | AZ |
Y | 213ES0103X | Foot & Ankle Surgery | 0749 | AZ |
N | 213ES0103X | Foot & Ankle Surgery | 36.003566 | OH |
N | 213ES0103X | Foot & Ankle Surgery | 5901002287 | MI |
NPI | 1053554600 |
---|---|
Provider Name | Ryan T Scott |
First Address | Phoenix, AZ 85023-1261 |
Second Address | Phoenix, AZ 85037-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2009 |
Last Update Date | 25/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3147786 | (05) | OH |
710806 | (05) | AZ |