Provider Demographics
NPI:1518024843
Name:SCOTT, STEVEN M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 KALISTE SALOOM ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-2636
Mailing Address - Country:US
Mailing Address - Phone:337-234-5234
Mailing Address - Fax:337-235-2121
Practice Address - Street 1:1103 KALISTE SALOOM ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-2636
Practice Address - Country:US
Practice Address - Phone:337-234-5234
Practice Address - Fax:337-235-2121
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA A10233363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAS18034Medicare UPIN
LA5DE57PA42Medicare PIN