Provider Demographics
NPI:1821189812
Name:DAVIS, SCOTT REID (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:REID
Last Name:DAVIS
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 1:9300 STOCKDALE HIGHWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311
Mailing Address - Country:US
Mailing Address - Phone:661-663-8483
Mailing Address - Fax:661-663-3095
Practice Address - Street 1:9300 STOCKDALE HIGHWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311
Practice Address - Country:US
Practice Address - Phone:661-663-8483
Practice Address - Fax:661-663-3095
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3965213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000E39650OtherBLUE SHIELD
U66611Medicare UPIN
000E39650OtherBLUE SHIELD