Provider Demographics
NPI:1205587128
Name:SCOTT, JAMES III
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:SCOTT
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19936 VAN AKEN BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3604
Mailing Address - Country:US
Mailing Address - Phone:216-470-8022
Mailing Address - Fax:
Practice Address - Street 1:19936 VAN AKEN BLVD APT 101
Practice Address - Street 2:
Practice Address - City:SHAKER HTS
Practice Address - State:OH
Practice Address - Zip Code:44122-3604
Practice Address - Country:US
Practice Address - Phone:216-470-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist