Provider Demographics
NPI:1407986730
Name:SCOTT MACLEOD DO LTD
Entity Type:Organization
Organization Name:SCOTT MACLEOD DO LTD
Other - Org Name:DERMATHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-796-7546
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:SUITE 512
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-796-7546
Mailing Address - Fax:702-869-6146
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-796-7546
Practice Address - Fax:702-869-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV610207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00287084OtherRR MEDICARE
NVCC8832OtherBCBS
NVF25109Medicare UPIN
NVV100705Medicare PIN