Provider Demographics
NPI:1801869441
Name:SCAFF, BRUCE E (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:SCAFF
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 1:2401 JARRATT AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-2430
Mailing Address - Country:US
Mailing Address - Phone:512-466-5473
Mailing Address - Fax:512-320-1935
Practice Address - Street 1:2401 JARRATT AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-2430
Practice Address - Country:US
Practice Address - Phone:512-466-5473
Practice Address - Fax:512-320-1935
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98302841Medicaid
TXR0046012OtherDPS
TX131645705Medicaid
TX131645711Medicaid
TX131645711Medicaid
TX8F3557Medicare PIN
TX89T473Medicare PIN
TX131645705Medicaid
TXR0046012OtherDPS