Provider Demographics
NPI:1194707109
Name:SCOTT, ROBERT W (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:SCOTT
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:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3502 9TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3300
Practice Address - Country:US
Practice Address - Phone:806-743-1188
Practice Address - Fax:806-743-1187
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6626208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100990101Medicaid
NM94278521Medicaid
TX159049901Medicaid
TX8G6052OtherBC/BS
NMA565OtherTRIWEST
TX100990100OtherFIRSTCARE COMMERCIAL
OK200012110AMedicaid
TX159049902Medicaid
TX87346ZOtherHMO BLUE
TXP00037953Medicare ID - Type UnspecifiedRAILROAD
NM94278521Medicaid
TXH88134Medicare UPIN