Provider Demographics
NPI:1760461800
Name:EWING, SCOTT E (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:EWING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-332-9093
Practice Address - Street 1:508 S ADAMS ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2151
Practice Address - Country:US
Practice Address - Phone:817-332-5099
Practice Address - Fax:817-332-9093
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7372207RC0000X, 207RI0011X, 207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166774304Medicaid
TX0057MPOtherBCBS
TX166774310Medicaid
P00660206OtherRAILROAD MEDICARE