Provider Demographics
NPI:1679655682
Name:SCOTT, JON M (DO)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:M
Last Name:SCOTT
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1150 SCOTT BLVD
Mailing Address - Street 2:SUITE D1
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4547
Mailing Address - Country:US
Mailing Address - Phone:408-246-9915
Mailing Address - Fax:408-246-0187
Practice Address - Street 1:1150 SCOTT BLVD
Practice Address - Street 2:SUITE D1
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4547
Practice Address - Country:US
Practice Address - Phone:408-246-9915
Practice Address - Fax:408-246-0187
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2010-04-08
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Provider Licenses
StateLicense IDTaxonomies
CA2OA5858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE97651Medicare UPIN