Provider Demographics
NPI:1336155159
Name:ELROD, SCOTT EUGEN (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EUGEN
Last Name:ELROD
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 1:125 BANK ST
Mailing Address - Street 2:SUITE #310
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4407
Mailing Address - Country:US
Mailing Address - Phone:406-549-7325
Mailing Address - Fax:
Practice Address - Street 1:125 BANK ST
Practice Address - Street 2:SUITE #310
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4407
Practice Address - Country:US
Practice Address - Phone:406-549-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT68752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000008586Medicare ID - Type Unspecified
MTE99585Medicare UPIN