# GLEN SCOTT

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1386245579
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 17663 | FL | — |
| 363A00000X | Physician Assistant | PA9113805 | FL | Yes |
| 363AM0700X | Medical Physician Assistant | 5601011920 | MI | — |

## Other

- **Enumeration date:** 11/04/2020
- **Last updated:** 10/30/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5315245193 | MICHIGAN CONTROLLED SUBSTANCE LICENSE | MI |
| 01 | — | 5601011920 | MI PHYSICIAN ASSISTANT LICENSE | MI |