Basic Information
| Provider Information | |||||||||
| NPI: | 1922118470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19036 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0393817272 | ||||||||
| FaxNumber: | 0393817269 | ||||||||
| Practice Location | |||||||||
| Address1: | 709 HOLLYBROOK DR | ||||||||
| Address2: | SUITE 2301 | ||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756052411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037575804 | ||||||||
| FaxNumber: | 9032322889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 11/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | G5587 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 130247308 | 05 | TX | MEDICAID |