Provider Demographics
NPI:1891769451
Name:SCOTT, ROBERT JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WARDER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2500
Mailing Address - Country:US
Mailing Address - Phone:937-328-2314
Mailing Address - Fax:937-328-2303
Practice Address - Street 1:30 WARDER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2500
Practice Address - Country:US
Practice Address - Phone:937-328-2314
Practice Address - Fax:937-328-2303
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038810208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0295989Medicaid
D31992Medicare UPIN
OH0295989Medicaid