Provider Demographics
NPI:1811994353
Name:SCOTT, RANDOLPH FRITZ (DO)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:FRITZ
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2222 N CRAYCROFT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2830
Mailing Address - Country:US
Mailing Address - Phone:520-290-9606
Mailing Address - Fax:520-290-6478
Practice Address - Street 1:2222 N CRAYCROFT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2830
Practice Address - Country:US
Practice Address - Phone:520-290-9606
Practice Address - Fax:520-290-6478
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE52329Medicare UPIN