Provider Demographics
NPI:1629246756
Name:MICHAEL B. SCOTT, M.D., INC.
Entity Type:Organization
Organization Name:MICHAEL B. SCOTT, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BERTNICE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-537-9230
Mailing Address - Street 1:3637 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3511
Mailing Address - Country:US
Mailing Address - Phone:310-537-9230
Mailing Address - Fax:310-537-9022
Practice Address - Street 1:3637 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3511
Practice Address - Country:US
Practice Address - Phone:310-537-9230
Practice Address - Fax:310-537-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG226942088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty