Provider Demographics
NPI:1881671055
Name:SCOTT, WILLIAM PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PATRICK
Last Name:SCOTT
Suffix:
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:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-0578
Mailing Address - Country:US
Mailing Address - Phone:479-229-6191
Mailing Address - Fax:479-229-6194
Practice Address - Street 1:200 N 3RD
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834
Practice Address - Country:US
Practice Address - Phone:479-229-6191
Practice Address - Fax:479-229-6194
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1903208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136054001Medicaid
AR136054001Medicaid
AR5K943Medicare ID - Type Unspecified