Provider Demographics
NPI:1457596272
Name:FEARS, SCOTT C (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:FEARS
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 1:300 MEDICAL PLZ
Mailing Address - Street 2:SUITE 2339
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:213-399-4163
Mailing Address - Fax:213-477-2280
Practice Address - Street 1:300 MEDICAL PLZ
Practice Address - Street 2:SUITE 2339
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:213-399-4163
Practice Address - Fax:213-477-2280
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA871692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA390ZMedicare PIN