Provider Demographics
NPI:1033144373
Name:SCOTT, WARREN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:ALAN
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5161 SOQUEL DR
Mailing Address - Street 2:SUITE #B
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2560
Mailing Address - Country:US
Mailing Address - Phone:831-479-7800
Mailing Address - Fax:831-479-7089
Practice Address - Street 1:5161 SOQUEL DR
Practice Address - Street 2:SUITE #B
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2560
Practice Address - Country:US
Practice Address - Phone:831-479-7800
Practice Address - Fax:831-479-7089
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52014204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F10726Medicare UPIN
CA00G520140Medicare ID - Type Unspecified