Provider Demographics
NPI:1437565066
Name:KING-SCOTT, ANTONIO D
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:D
Last Name:KING-SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W PINHOOK RD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2448
Mailing Address - Country:US
Mailing Address - Phone:337-258-7369
Mailing Address - Fax:888-678-5014
Practice Address - Street 1:1001 W PINHOOK RD
Practice Address - Street 2:SUITE 219
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2448
Practice Address - Country:US
Practice Address - Phone:337-258-7369
Practice Address - Fax:888-678-5014
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor