Provider Demographics
NPI:1881692317
Name:SCOTT, BRUCE A (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6420 DUTCHMANS PKWY
Mailing Address - Street 2:380
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3372
Mailing Address - Country:US
Mailing Address - Phone:502-894-8441
Mailing Address - Fax:502-894-4453
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:380
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-894-8441
Practice Address - Fax:502-894-4453
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01041529B207Y00000X
KY29592207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64295926Medicaid
KY000000045446OtherANTHEM FACET NUMBER
KY04006864OtherRAIL ROAD MEDICARE
IN100347690AMedicaid
KY000000045446OtherANTHEM FACET NUMBER
IN195900CMedicare ID - Type UnspecifiedINDIANA MEDICARE
IN100347690AMedicaid