Provider Demographics
NPI:1609961812
Name:SCOLARO, PHILIP ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ALAN
Last Name:SCOLARO
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 1:3802 22ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1107
Mailing Address - Country:US
Mailing Address - Phone:806-791-0188
Mailing Address - Fax:806-788-0470
Practice Address - Street 1:3802 22ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1107
Practice Address - Country:US
Practice Address - Phone:806-791-0188
Practice Address - Fax:806-788-0470
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0799207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120401803Medicaid
TX8CD477OtherBCBS
TX8CD477OtherBCBS
TX00D09YMedicare ID - Type Unspecified