Provider Demographics
NPI:1306896162
Name:MATSON, SCOTT (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MATSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 CHURCH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-3004
Mailing Address - Country:US
Mailing Address - Phone:423-626-2410
Mailing Address - Fax:423-626-2591
Practice Address - Street 1:1720 CHURCH ST STE 4
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3004
Practice Address - Country:US
Practice Address - Phone:423-626-2410
Practice Address - Fax:423-626-2591
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1498207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942567326OtherNPI
TN1521614Medicaid
KY64131386Medicaid
KY64131386Medicaid
TN103I166839Medicare PIN