Provider Demographics
NPI:1255350708
Name:FOXWORTH, SCOTT STEVEN-FLYNN (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:STEVEN-FLYNN
Last Name:FOXWORTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 N MCCOLL RD APT 1317
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9151
Mailing Address - Country:US
Mailing Address - Phone:936-645-3602
Mailing Address - Fax:956-362-2448
Practice Address - Street 1:2821 MICHAELANGELO DR STE 306
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1418
Practice Address - Country:US
Practice Address - Phone:956-362-2440
Practice Address - Fax:956-362-2448
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05045363A00000X
MEPA001081363AS0400X
TXPA03742363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C8996Medicare PIN
NCNCJ942AMedicare PIN
TXP98803Medicare UPIN