Provider Demographics
NPI:1376867101
Name:SCOTT, LORETTA ANN (IDMT)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 STANFORD RD
Mailing Address - Street 2:APT. 702
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3589
Mailing Address - Country:US
Mailing Address - Phone:850-525-7938
Mailing Address - Fax:
Practice Address - Street 1:2401 STANFORD RD
Practice Address - Street 2:APT. 702
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3589
Practice Address - Country:US
Practice Address - Phone:850-525-7938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians