Provider Demographics
NPI:1629064878
Name:MCQUEEN, SCOTT C (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:MCQUEEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 E 17TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2641
Mailing Address - Country:US
Mailing Address - Phone:714-352-2911
Mailing Address - Fax:714-380-6235
Practice Address - Street 1:1206 E 17TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-352-2911
Practice Address - Fax:714-380-6235
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13655363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS36895Medicare UPIN
CAWPA13655CMedicare ID - Type Unspecified