Provider Demographics
NPI:1972663938
Name:BUIS, SCOTT DAVID (P,A,-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:BUIS
Suffix:
Gender:M
Credentials:P,A,-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 SAN DIMAS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5734
Mailing Address - Country:US
Mailing Address - Phone:661-324-6593
Mailing Address - Fax:
Practice Address - Street 1:2600 BLACKSTONE CT
Practice Address - Street 2:SUITE 102
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-5401
Practice Address - Country:US
Practice Address - Phone:661-324-6593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13789363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13789OtherCALIFORNIA STATE LICENSE
CAMB0873819OtherDEA NUMBER
CAPA13789OtherCALIFORNIA STATE LICENSE