Provider Demographics
NPI:1770661894
Name:MOREY, SCOTT ANTHONY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:MOREY
Suffix:JR
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 1:620 CALIFORNIA BLVD STE R
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2586
Mailing Address - Country:US
Mailing Address - Phone:805-439-4972
Mailing Address - Fax:805-439-4976
Practice Address - Street 1:620 CALIFORNIA BLVD STE R
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2586
Practice Address - Country:US
Practice Address - Phone:805-439-4972
Practice Address - Fax:805-439-4976
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66713207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A667130OtherBLUE SHIELD INDIVIDUAL PROVIDER NUMBER
CAA66713OtherMEDICARE INDIVIDUAL PIN NUMBER- NHIC
CABV205ZOtherMEDICARE PTAN - PALMETTO GBA
CAA66713OtherMEDICAL LICENSE NUMBER
CAA66713OtherMEDICAL LICENSE NUMBER