Provider Demographics
NPI:1528009198
Name:DULEBOHN, SCOTT C (M D)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:DULEBOHN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N STATE OF FRANKLIN RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6971
Mailing Address - Country:US
Mailing Address - Phone:423-431-2350
Mailing Address - Fax:423-431-2372
Practice Address - Street 1:410 N STATE OF FRANKLIN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6971
Practice Address - Country:US
Practice Address - Phone:423-431-2350
Practice Address - Fax:423-431-2372
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40265207T00000X
VA0101247383207T00000X
GUMTL-2023-001207T00000X
GUM-2375207T00000X
TNMD34821207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003378Medicaid
VA1528009198Medicaid
TNTN01A5OtherJOHN DEERE
TN4127300OtherBCBS OF TENNESSEE
NC1528009198Medicaid
TN3338931Medicaid
TN4127300OtherBCBS OF TENNESSEE
TN3338931Medicaid
NC1528009198Medicaid
TN3338931Medicare PIN