Provider Demographics
NPI:1831102482
Name:SCOTT, RICHARD L II (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:SCOTT
Suffix:II
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 1:2600 VIA DE LA VALLE
Mailing Address - Street 2:STE 200
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1992
Mailing Address - Country:US
Mailing Address - Phone:858-309-3160
Mailing Address - Fax:858-309-3179
Practice Address - Street 1:2600 VIA DE LA VALLE
Practice Address - Street 2:STE 200
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1992
Practice Address - Country:US
Practice Address - Phone:858-309-3160
Practice Address - Fax:858-309-3179
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72265207N00000X
CAG735732081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G722650Medicaid
CAC62804Medicare UPIN
CAWG72265BMedicare ID - Type Unspecified