Provider Demographics
NPI:1164509881
Name:BEARDEN, SCOTT GREGORY (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:GREGORY
Last Name:BEARDEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-5134
Mailing Address - Country:US
Mailing Address - Phone:469-443-0275
Mailing Address - Fax:469-443-0685
Practice Address - Street 1:901 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5134
Practice Address - Country:US
Practice Address - Phone:469-443-0275
Practice Address - Fax:469-443-0685
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK841363AM0700X
TXPA01612363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S49572Medicare UPIN
OKS49572Medicare UPIN