Provider Demographics
NPI:1881640449
Name:SAXON, SCOTT RAY (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RAY
Last Name:SAXON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837
Mailing Address - Country:US
Mailing Address - Phone:570-524-2722
Mailing Address - Fax:570-524-0362
Practice Address - Street 1:90 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9419
Practice Address - Country:US
Practice Address - Phone:570-524-2722
Practice Address - Fax:570-524-0362
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000204L363A00000X
PAMA000490L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102049N95Medicare ID - Type Unspecified
PAR06305Medicare UPIN