Provider Demographics
NPI:1124272307
Name:SCURTI, PAUL J (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:SCURTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 BAPTIST BLVD STE 301
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705
Practice Address - Country:US
Practice Address - Phone:662-244-1705
Practice Address - Fax:662-227-4301
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26756207R00000X
OH34.010245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810021016Medicaid
OH0051915Medicaid
OHH010770Medicare PIN