# GEORGE C SCOTT MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396061776
- **Authorized official:** GEORGE C SCOTT MD (OWNER)
- **Authorized official phone:** (415) 302-2506

## Contact information

- **Practice address:** 1191 E YOSEMITE AVE, STE C, MANTECA, CA 95336-5011
- **Practice address phone:** (209) 239-4100
- **Practice address fax:** (209) 239-4110
- **Mailing address:** 1191 E YOSEMITE AVE, STE C, MANTECA, CA 95336-5011
- **Mailing address phone:** (209) 239-4100
- **Mailing address fax:** (209) 239-4110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | G55402 | CA | Yes |

## Other

- **Enumeration date:** 04/11/2010
- **Last updated:** 09/03/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00G554020 | — | CA |
| 05 | — | 2176339 | — | CA |