Provider Demographics
NPI:1487618914
Name:WEIKLE, SCOTT CLAYTON (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CLAYTON
Last Name:WEIKLE
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 1:6 S POINSETT HWY
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1822
Mailing Address - Country:US
Mailing Address - Phone:864-834-7834
Mailing Address - Fax:864-834-7477
Practice Address - Street 1:6 S POINSETT HWY
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1822
Practice Address - Country:US
Practice Address - Phone:864-834-7834
Practice Address - Fax:864-834-7477
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4337Medicaid
SCGP4337Medicaid
SCAA06738427Medicare PIN