Provider Demographics
NPI:1811964570
Name:SCOTT, JEFFREY LEE (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEE
Last Name:SCOTT
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 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GREYBULL
Mailing Address - State:WY
Mailing Address - Zip Code:82426-2133
Mailing Address - Country:US
Mailing Address - Phone:307-209-3391
Mailing Address - Fax:307-202-4535
Practice Address - Street 1:6 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GREYBULL
Practice Address - State:WY
Practice Address - Zip Code:82426-2133
Practice Address - Country:US
Practice Address - Phone:307-209-3391
Practice Address - Fax:307-202-4535
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO23306207Q00000X
IDO-0836207Q00000X
WY13542A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH86561Medicare UPIN
OR161133OtherNBMC GROUP MEDICAID-DMAP #
OR930635514OtherNBMC GROUP TAX ID FOR BILLING
ORP01294526OtherMEDICARE RAILROAD
ORR0000WFBTVOtherNBMC-GROUP MEDICARE #
OR1407812365OtherNBMC GROUP NPI
ORH86561Medicare UPIN
OR383876Medicare Oscar/Certification
OR226857Medicaid
OR116176Medicare ID - Type Unspecified