Provider Demographics
NPI:1609073055
Name:MASTORES, SCOTT FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:FRANK
Last Name:MASTORES
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 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-1905
Mailing Address - Fax:765-935-1910
Practice Address - Street 1:1501 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1914
Practice Address - Country:US
Practice Address - Phone:765-935-1905
Practice Address - Fax:765-935-1910
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042444A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000705640OtherANTHEM - RPA
OH0068959Medicaid
IN200873010Medicaid
INM400040776Medicare PIN
INC03616Medicare UPIN