Provider Demographics
NPI:1265437925
Name:SCOTT, CRANFORD LAVERN (MD)
Entity type:Individual
Prefix:
First Name:CRANFORD
Middle Name:LAVERN
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 1010
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90308-1010
Mailing Address - Country:US
Mailing Address - Phone:310-673-6581
Mailing Address - Fax:310-419-4493
Practice Address - Street 1:233 N PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1412
Practice Address - Country:US
Practice Address - Phone:310-673-6581
Practice Address - Fax:310-419-4493
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2018-03-17
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CAC32142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW6041Medicare ID - Type Unspecified
CAA34821Medicare UPIN