Provider Demographics
NPI:1952830614
Name:BASTIAN, SCOTT L (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:BASTIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126B HIGHWAY 81 N
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1532
Mailing Address - Country:US
Mailing Address - Phone:864-231-6395
Mailing Address - Fax:
Practice Address - Street 1:2126B HIGHWAY 81 N
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1532
Practice Address - Country:US
Practice Address - Phone:864-231-6395
Practice Address - Fax:864-231-6520
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC708213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty