Provider Demographics
NPI:1992808893
Name:SCOTT, JARED M (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:M
Last Name:SCOTT
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 1:1906 S VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-3453
Mailing Address - Country:US
Mailing Address - Phone:208-433-1114
Mailing Address - Fax:208-433-1115
Practice Address - Street 1:1906 S VISTA AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3453
Practice Address - Country:US
Practice Address - Phone:208-433-1114
Practice Address - Fax:208-433-1115
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10116207ND0101X, 207NS0135X, 207N00000X, 207NS0135X
CT045048207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology