Provider Demographics
NPI:1689692444
Name:DOBSON, SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:DOBSON
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 1:525 VERDAE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4021
Mailing Address - Country:US
Mailing Address - Phone:864-272-0388
Mailing Address - Fax:864-213-9237
Practice Address - Street 1:211 BATESVILLE RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4816
Practice Address - Country:US
Practice Address - Phone:864-272-0388
Practice Address - Fax:864-213-9237
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24580208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC24580OtherSTATE LICENSE #
SC11622238OtherCAQH #
SC245808Medicaid
SC203730220OtherTAX ID #
SC11622238OtherCAQH #