Provider Demographics
NPI:1669485645
Name:SCOTT, CLIFFORD TYLER (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:TYLER
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 1:3150 CLARKSVILLE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-8076
Mailing Address - Country:US
Mailing Address - Phone:903-782-9206
Mailing Address - Fax:903-783-7367
Practice Address - Street 1:3150 CLARKSVILLE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-8076
Practice Address - Country:US
Practice Address - Phone:903-782-9206
Practice Address - Fax:903-783-7367
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136270910Medicaid
TX8D3246Medicare ID - Type Unspecified
TX136270910Medicaid