Provider Demographics
NPI:1669439048
Name:SCOTT, JOHN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:SCOTT
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 1:5560 KIETZKE LN BLDG A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3019
Mailing Address - Country:US
Mailing Address - Phone:775-322-7811
Mailing Address - Fax:
Practice Address - Street 1:5560 KIETZKE LN BLDG A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3019
Practice Address - Country:US
Practice Address - Phone:775-322-7811
Practice Address - Fax:775-322-1431
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2945208800000X
AZ37557208800000X
CAG21289208800000X
NV19244208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z130284Medicare PIN
A41239Medicare UPIN
34WCGXL02Medicare ID - Type Unspecified
Z133632Medicare PIN