Provider Demographics
NPI:1386969442
Name:R. SCOTT BEVAN DPM PC
Entity type:Organization
Organization Name:R. SCOTT BEVAN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-243-3801
Mailing Address - Street 1:PO BOX 171258
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-1258
Mailing Address - Country:US
Mailing Address - Phone:801-243-3801
Mailing Address - Fax:307-886-5652
Practice Address - Street 1:998 COUNTY ROAD 148
Practice Address - Street 2:
Practice Address - City:SMOOT
Practice Address - State:WY
Practice Address - Zip Code:83126
Practice Address - Country:US
Practice Address - Phone:801-243-3801
Practice Address - Fax:307-886-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty