Provider Demographics
NPI:1598746307
Name:JAMES D SCOTT MD PC
Entity Type:Organization
Organization Name:JAMES D SCOTT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PROFFESSIONAL CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-673-3259
Mailing Address - Street 1:300 INDEPENDENCE LN
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-9540
Mailing Address - Country:US
Mailing Address - Phone:541-673-3259
Mailing Address - Fax:541-673-3259
Practice Address - Street 1:300 INDEPENDENCE LN
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-9540
Practice Address - Country:US
Practice Address - Phone:541-673-3259
Practice Address - Fax:541-673-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07736207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR177352Medicaid
OR177352Medicaid
C90930Medicare UPIN