Provider Demographics
NPI:1265433080
Name:ELKIN, SCOTT R (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:ELKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY #450
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1024
Mailing Address - Country:US
Mailing Address - Phone:512-306-0061
Mailing Address - Fax:512-306-0069
Practice Address - Street 1:3705 MEDICAL PKWY #450
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1024
Practice Address - Country:US
Practice Address - Phone:512-306-0061
Practice Address - Fax:512-306-0069
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG16442084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6579OtherBLUE CROSS
TX8F10233OtherMEDICARE PTAN
TX00N08VOtherBCBS
TX132050902Medicaid
TXP00009409OtherRAILROAD MEDICARE
TX8F10233OtherMEDICARE PTAN
TX8A6579Medicare ID - Type Unspecified
TX00N08VOtherBCBS