Provider Demographics
NPI:1053455626
Name:SCOTT, MARK PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:PATRICK
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 W PUEBLO ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-6219
Mailing Address - Country:US
Mailing Address - Phone:805-682-7751
Mailing Address - Fax:805-563-2527
Practice Address - Street 1:514 W PUEBLO ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6219
Practice Address - Country:US
Practice Address - Phone:805-682-7751
Practice Address - Fax:805-563-2527
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70915207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A709150Medicaid
WA70915AMedicare PIN
CA00A709150Medicaid