Provider Demographics
NPI:1417067455
Name:PRICE, SCOTT R (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:PRICE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2240
Mailing Address - Country:US
Mailing Address - Phone:928-710-5014
Mailing Address - Fax:928-775-3250
Practice Address - Street 1:3149 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2240
Practice Address - Country:US
Practice Address - Phone:928-772-5916
Practice Address - Fax:928-775-3250
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0564213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ35-2210138OtherAETNA
AZAZ0195490OtherBLUE CROSS BLUE SHIELD
AZP00198294OtherRAIL ROAD MEDICARE
AZ35-2210138OtherAZ FOUNDATION
AZDC9191OtherRAIL RD MEDICARE
AZU90491Medicare UPIN
AZ35-2210138OtherAETNA
AZDC9191OtherRAIL RD MEDICARE
AZ35-2210138OtherAZ FOUNDATION
AZ100470Medicare ID - Type UnspecifiedGROUP
AZ35-2210138OtherAZ FOUNDATION