Provider Demographics
NPI:1043319916
Name:SCOTT, DAVID BRUCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRUCE
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 S 23RD ST APT 157
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-6645
Mailing Address - Country:US
Mailing Address - Phone:515-230-1754
Mailing Address - Fax:765-935-0745
Practice Address - Street 1:2100 E LAKE COOK RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1999
Practice Address - Country:US
Practice Address - Phone:800-317-0711
Practice Address - Fax:800-434-7113
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI887-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000550791OtherANTHEM BCBS
WIP00144281OtherRAILROAD
IN200878300Medicaid
WI43237000Medicaid
IN144340SMedicare PIN
WIP00144281OtherRAILROAD
WIV01427Medicare UPIN
WI43237000Medicaid