Basic Information
| Provider Information | |||||||||
| NPI: | 1730406596 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANGERT | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6296 E GRANT RD | ||||||||
| Address2: | STE. 180 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857125833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202908555 | ||||||||
| FaxNumber: | 5202906470 | ||||||||
| Practice Location | |||||||||
| Address1: | 6296 E GRANT RD | ||||||||
| Address2: | STE. 180 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857125833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202908555 | ||||||||
| FaxNumber: | 5202906470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2010 | ||||||||
| LastUpdateDate: | 06/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | M3886 | TX | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 44289 | AZ | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.