Provider Demographics
NPI:1295027787
Name:SCOTTO, SARAH LYNN (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:SCOTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1455 E BERT KOUN LOOP
Mailing Address - Street 2:SUITE #308
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5634
Mailing Address - Country:US
Mailing Address - Phone:318-798-4400
Mailing Address - Fax:318-798-4531
Practice Address - Street 1:1455 E BERT KOUN LOOP
Practice Address - Street 2:SUITE #308
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5634
Practice Address - Country:US
Practice Address - Phone:318-798-4400
Practice Address - Fax:318-798-4531
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA207783207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2144324Medicaid
LA2144324Medicaid