Provider Demographics
NPI:1942264692
Name:SCOTT, EWELL G (MD)
Entity Type:Individual
Prefix:
First Name:EWELL
Middle Name:G
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 1:234 MEDICAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1181
Mailing Address - Country:US
Mailing Address - Phone:606-784-6641
Mailing Address - Fax:606-783-7281
Practice Address - Street 1:234 MEDICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1181
Practice Address - Country:US
Practice Address - Phone:606-784-6641
Practice Address - Fax:606-780-2373
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64161391Medicaid
KY1274503Medicare ID - Type Unspecified
KY64161391Medicaid