Provider Demographics
NPI:1548246242
Name:PAXTON, SCOTT A (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:PAXTON
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:W2850 STATE ROAD 28
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-2702
Mailing Address - Country:US
Mailing Address - Phone:920-467-1800
Mailing Address - Fax:920-467-1900
Practice Address - Street 1:W2850 STATE ROAD 28
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085-2702
Practice Address - Country:US
Practice Address - Phone:920-467-1800
Practice Address - Fax:920-467-1900
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013909207Q00000X
WI1800207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0858207125OtherBCBS INDIVIDUAL
WI100218169Medicaid
MI700H219150OtherBLUE SHIELD
MI1548246242Medicaid
WI1800OtherSTATE LICENSE