Provider Demographics
NPI:1417192196
Name:SCOTT, JACK ARNOLD (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:ARNOLD
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3147
Mailing Address - Country:US
Mailing Address - Phone:412-915-9521
Mailing Address - Fax:
Practice Address - Street 1:1534 W SHORE DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3147
Practice Address - Country:US
Practice Address - Phone:412-915-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36726174400000X
PAMD028380L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist