Provider Demographics
NPI:1538131578
Name:SCORTT, LARRY D (DPM)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:SCORTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 N MILBURN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-0022
Mailing Address - Country:US
Mailing Address - Phone:559-224-5101
Mailing Address - Fax:559-224-4396
Practice Address - Street 1:7210 N MILBURN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-0022
Practice Address - Country:US
Practice Address - Phone:559-224-5101
Practice Address - Fax:559-224-4396
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2629213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E26290Medicaid
CA480022521OtherRAILROAD MEDICARE
CA000E26290Medicare PIN
CAT11411Medicare UPIN
CA0268630001Medicare NSC