Individual
JOHN SCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1235 8TH ST, LAS VEGAS, NM 87701-4219
(505) 425-6788
(505) 425-5408
Mailing address
PO BOX 158, ESPANOLA, NM 87532-0158
(505) 753-7218
(505) 747-7396
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PA2016-0036
NM
363AM0700X
Medical Physician Assistant
0110840842
VA
363AM0700X
Medical Physician Assistant
PA30149
DC
Other
Enumeration date
10/12/2006
Last updated
07/21/2022
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