Provider Demographics
NPI:1902157720
Name:DELHOM, SCOTT PAUL
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:PAUL
Last Name:DELHOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11552 CEDAR PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-4252
Mailing Address - Country:US
Mailing Address - Phone:225-755-0888
Mailing Address - Fax:225-755-0022
Practice Address - Street 1:11552 CEDAR PARK AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-4252
Practice Address - Country:US
Practice Address - Phone:225-755-0888
Practice Address - Fax:225-755-0022
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17-0010476332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4243510001Medicare NSC