Provider Demographics
NPI:1689785677
Name:SCOTT, FRED DESHONG (DO)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:DESHONG
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HOSPITAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8558
Mailing Address - Country:US
Mailing Address - Phone:304-269-8504
Mailing Address - Fax:304-269-8162
Practice Address - Street 1:230 HOSPITAL PLAZA
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8558
Practice Address - Country:US
Practice Address - Phone:304-269-8504
Practice Address - Fax:304-269-8162
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1877207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1807845000Medicaid
WV1807845000Medicaid
WVSC4066356Medicare PIN
OHSC4066357Medicare PIN
WVG00169Medicare UPIN
WV1807845000Medicaid