Provider Demographics
NPI:1417151044
Name:JEFFREY SCOTT, MD INC
Entity Type:Organization
Organization Name:JEFFREY SCOTT, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-575-7520
Mailing Address - Street 1:1521 N CARPENTER RD STE D1
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-1217
Mailing Address - Country:US
Mailing Address - Phone:209-575-7520
Mailing Address - Fax:209-575-7515
Practice Address - Street 1:1521 N CARPENTER RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1147
Practice Address - Country:US
Practice Address - Phone:209-163-8230
Practice Address - Fax:209-575-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA801042081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty