Provider Demographics
NPI:1205921244
Name:FORD, SCOTT PHILIP (PA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:PHILIP
Last Name:FORD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 N KANSAS
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66617
Mailing Address - Country:US
Mailing Address - Phone:785-246-0011
Mailing Address - Fax:785-272-0894
Practice Address - Street 1:1119 GAGE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604
Practice Address - Country:US
Practice Address - Phone:785-272-4000
Practice Address - Fax:785-272-0894
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0015243363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical