Provider Demographics
NPI:1114172566
Name:SCOTT, KEITH WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:WESLEY
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 1:1349 ALTOONA PILLAR ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ROSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98643-9614
Mailing Address - Country:US
Mailing Address - Phone:860-508-3109
Mailing Address - Fax:
Practice Address - Street 1:1349 ALTOONA PILLAR ROCK RD
Practice Address - Street 2:
Practice Address - City:ROSBURG
Practice Address - State:WA
Practice Address - Zip Code:98643-9614
Practice Address - Country:US
Practice Address - Phone:860-508-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-27
Last Update Date:2008-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0271882084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry