Provider Demographics
NPI:1225408743
Name:MAYMON, SCOTT (NMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MAYMON
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 W CALLE IGLESIA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5534
Mailing Address - Country:US
Mailing Address - Phone:480-427-0442
Mailing Address - Fax:
Practice Address - Street 1:2255 W CALLE IGLESIA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5534
Practice Address - Country:US
Practice Address - Phone:480-427-0442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-26
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15-1497175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath