Provider Demographics
NPI:1841359189
Name:SCOCCIA, VINCENT FRANK (DO)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:FRANK
Last Name:SCOCCIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294898
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-4898
Mailing Address - Country:US
Mailing Address - Phone:775-482-4077
Mailing Address - Fax:830-896-4343
Practice Address - Street 1:707 HILL COUNTRY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5996
Practice Address - Country:US
Practice Address - Phone:830-896-0404
Practice Address - Fax:830-896-4343
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV869207R00000X
TXM5995207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH002012043Medicaid
OHF93911Medicare UPIN
OHF93911Medicare UPIN