Provider Demographics
NPI:1285659219
Name:SCOTT, GLENN L (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:L
Last Name:SCOTT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:900 SOUTH PINE STREET
Mailing Address - Street 2:STE A
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302
Mailing Address - Country:US
Mailing Address - Phone:864-582-3456
Mailing Address - Fax:864-583-3579
Practice Address - Street 1:900 SOUTH PINE STREET
Practice Address - Street 2:STE A
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302
Practice Address - Country:US
Practice Address - Phone:864-582-3456
Practice Address - Fax:864-583-3579
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-08-25
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Provider Licenses
StateLicense IDTaxonomies
SC6850207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC068508Medicaid
SCC613402914Medicare ID - Type UnspecifiedGLENN L SCOTT, MD
SC068508Medicaid