Provider Demographics
NPI:1013955087
Name:PAVEY, SCOTT ARNOLD (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ARNOLD
Last Name:PAVEY
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 1:1615 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-5934
Mailing Address - Country:US
Mailing Address - Phone:817-684-3500
Mailing Address - Fax:817-684-3510
Practice Address - Street 1:1615 HOSPITAL PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5934
Practice Address - Country:US
Practice Address - Phone:817-684-3500
Practice Address - Fax:817-684-3510
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038201202Medicaid
TX080185926OtherRAILROAD MEDICARE
TX038201203Medicaid
TXB25401Medicare UPIN
TX080185926OtherRAILROAD MEDICARE