Provider Demographics
NPI:1528023835
Name:SCOTT, TARA DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:DIANE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:707-576-4070
Mailing Address - Fax:707-576-4087
Practice Address - Street 1:34 MARK WEST SPRINGS RD FL 2
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-576-4070
Practice Address - Fax:707-576-4087
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CAA83951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA83951OtherSTATE MEDICAL LICNESE
CABS8590398OtherFEDERAL DEA LICENSE