Provider Demographics
NPI:1104930361
Name:SLEDGE, SCOTT LINDEN (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:LINDEN
Last Name:SLEDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3987
Mailing Address - Country:US
Mailing Address - Phone:210-494-9600
Mailing Address - Fax:210-494-9601
Practice Address - Street 1:155 E SONTERRA BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3987
Practice Address - Country:US
Practice Address - Phone:210-494-9600
Practice Address - Fax:210-494-9601
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0821207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110415003Medicaid
TX8B2607Medicare PIN
TX110415003Medicaid