Provider Demographics
NPI:1205881489
Name:SCOTT, HEATH ELLIOTT (MD)
Entity type:Individual
Prefix:
First Name:HEATH
Middle Name:ELLIOTT
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:PO BOX 1509
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-1509
Mailing Address - Country:US
Mailing Address - Phone:662-746-6083
Mailing Address - Fax:662-746-1954
Practice Address - Street 1:805 E FIFTEENTH ST
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-7607
Practice Address - Country:US
Practice Address - Phone:662-746-6083
Practice Address - Fax:662-746-1954
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08201774Medicaid
MSIO8557Medicare UPIN