Provider Demographics
NPI:1629075585
Name:TRUFANT, SCOTT K (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:K
Last Name:TRUFANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-4950
Mailing Address - Fax:704-316-4951
Practice Address - Street 1:7752 GATEWAY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4414
Practice Address - Country:US
Practice Address - Phone:704-316-4950
Practice Address - Fax:704-316-4951
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912712WMedicaid
NC891271RWMedicaid
NC2281316BMedicare PIN
NC8912712WMedicaid