Basic Information
| Provider Information | |||||||||
| NPI: | 1194707109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432898 | ||||||||
| FaxNumber: | 8067432787 | ||||||||
| Practice Location | |||||||||
| Address1: | 3502 9TH ST | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794153300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067431188 | ||||||||
| FaxNumber: | 8067431187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | L6626 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 100990101 | 05 | TX | MEDICAID | 94278521 | 05 | NM | MEDICAID | 159049901 | 05 | TX | MEDICAID | 8G6052 | 01 | TX | BC/BS | OTHER | A565 | 01 | NM | TRIWEST | OTHER | 100990100 | 01 | TX | FIRSTCARE COMMERCIAL | OTHER | 200012110A | 05 | OK | MEDICAID | 159049902 | 05 | TX | MEDICAID | 87346Z | 01 | TX | HMO BLUE | OTHER |