Provider Demographics
NPI:1285789065
Name:FLEISCHAUER, SCOTT LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LAWRENCE
Last Name:FLEISCHAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:LAWRENCE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:801 ROAD TO SIX FLAGS W
Practice Address - Street 2:#105
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2616
Practice Address - Country:US
Practice Address - Phone:817-274-6532
Practice Address - Fax:817-548-8744
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4066207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00784604OtherRAILROAD MEDICARE
TX204779701Medicaid
AR164168001Medicaid
AR5N823Medicare PIN
TXP00784604OtherRAILROAD MEDICARE
ARI 72824Medicare UPIN