Provider Demographics
NPI:1629365317
Name:SCOTT, DOUGLAS N (LSA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:N
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:STE 618
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3560
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:713-457-5188
Practice Address - Street 1:2033 LAKESIDE LNDG
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-8302
Practice Address - Country:US
Practice Address - Phone:832-267-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123054246ZC0007X
363AS0400X
TXSA00576246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8TC360OtherUNIVERSAL SURGICAL ASSISTANTS
TX8TY712OtherXCITE SURGICAL
TX8UB510OtherBLUE STAR SURGICAL
TX8UC324OtherUNIVERSAL SURGICAL PARTNERS
TX8TY713OtherUS MSO