Provider Demographics
NPI:1780624254
Name:ALLISON, SCOTT ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:ALLISON
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 1:11995 SINGLETREE LN STE 500
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:11995 SINGLETREE LN STE 500
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344
Practice Address - Country:US
Practice Address - Phone:952-595-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM60132085R0204X, 2085R0202X
OK223422085R0202X
SC393042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AL153OtherBCBS
TX182524301Medicaid
TX185254303Medicaid
TX185254306Medicaid
TX185254304Medicaid
TX185254305OtherCSHCN
TX8J5678Medicare PIN
TX8L13722Medicare PIN
TX8AL153OtherBCBS
TX8J5677Medicare PIN
TX8J5676Medicare PIN
TX182524301Medicaid