Provider Demographics
NPI:1447787171
Name:DITCH, SCOTT
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:DITCH
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:ONE BAYLOR PLAZA, BCM 620
Mailing Address - Street 2:BAYLOR COLLEGE OF MEDICINE, MEDICINE RESIDENCY OFFICE
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8767 WILSHIRE BLVD FL 3
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2714
Practice Address - Country:US
Practice Address - Phone:310-385-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10060326207R00000X
CAA169495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine