Provider Demographics
NPI:1811085715
Name:SCOTT, TERRI JO (MD)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:JO
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17189 INTERSTATE 45 S STE 395
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3319
Mailing Address - Country:US
Mailing Address - Phone:936-270-3662
Mailing Address - Fax:936-270-4748
Practice Address - Street 1:17189 INTERSTATE 45 S STE 395
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3319
Practice Address - Country:US
Practice Address - Phone:936-270-3662
Practice Address - Fax:936-270-4748
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2790207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105352203Medicaid
TXH21348Medicare UPIN
TX105352203Medicaid
TX8A9961Medicare PIN
TXTXB102946Medicare PIN
TXTXB131079Medicare PIN