Provider Demographics
NPI:1821056128
Name:BEAIRSTO, SCOTT MITCHELL (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MITCHELL
Last Name:BEAIRSTO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BONAIRE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6827
Mailing Address - Country:US
Mailing Address - Phone:337-337-9089
Mailing Address - Fax:
Practice Address - Street 1:205 BONAIRE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6827
Practice Address - Country:US
Practice Address - Phone:504-889-0347
Practice Address - Fax:504-779-9741
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD319R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00336354OtherRRMCARE PIN #
LA1715441Medicaid
LAP00336354OtherRRMCARE PIN #
LA1715441Medicaid