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Individual
GLEN SCOTT
Active
Individual
GLEN SCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
17663
FL
363A00000X
Physician Assistant
Primary
PA9113805
FL
363AM0700X
Medical Physician Assistant
5601011920
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5315245193
MICHIGAN CONTROLLED SUBSTANCE LICENSE
MI
01
—
5601011920
MI PHYSICIAN ASSISTANT LICENSE
MI
Enumeration date
11/04/2020
Last updated
10/30/2023
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