Provider Demographics
NPI:1588845697
Name:JOSEPH, SCOTT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HEAPHY PLACE
Mailing Address - Street 2:PUKEHANGI
Mailing Address - City:ROTORUA
Mailing Address - State:ROTORUA
Mailing Address - Zip Code:3201
Mailing Address - Country:NZ
Mailing Address - Phone:0116427-477-7551
Mailing Address - Fax:
Practice Address - Street 1:21 HEAPHY PLACE
Practice Address - Street 2:PUKEHANGI
Practice Address - City:ROTORUA
Practice Address - State:ROTORUA
Practice Address - Zip Code:3201
Practice Address - Country:NZ
Practice Address - Phone:0116427-477-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL169472084P0800X
NMMD2005-01902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF32910Medicare UPIN