Provider Demographics
NPI:1730108093
Name:DOHERTY, SCOTT ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:9971 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-9525
Mailing Address - Country:US
Mailing Address - Phone:251-660-3500
Mailing Address - Fax:251-660-3501
Practice Address - Street 1:6701 AIRPORT BLVD STE D144
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6701
Practice Address - Country:US
Practice Address - Phone:251-660-3503
Practice Address - Fax:251-660-3504
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL#267213ES0103X
ORDP150357213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery