Provider Demographics
NPI:1093797532
Name:SCIORTINO, JOHN S (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:SCIORTINO
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 1:3415 LOY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1744
Mailing Address - Country:US
Mailing Address - Phone:903-893-9661
Mailing Address - Fax:903-868-2975
Practice Address - Street 1:3415 LOY LAKE RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1744
Practice Address - Country:US
Practice Address - Phone:903-893-9661
Practice Address - Fax:903-868-2975
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0817213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092785701Medicaid
TX85X719Medicare PIN
TXT15803Medicare UPIN
TX4264580001Medicare NSC