Provider Demographics
NPI:1730406596
Name:BANGERT, SCOTT DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:BANGERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6296 E GRANT RD
Mailing Address - Street 2:STE. 180
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5833
Mailing Address - Country:US
Mailing Address - Phone:520-290-8555
Mailing Address - Fax:520-290-6470
Practice Address - Street 1:6296 E GRANT RD
Practice Address - Street 2:STE. 180
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5833
Practice Address - Country:US
Practice Address - Phone:520-290-8555
Practice Address - Fax:520-290-6470
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM3886207N00000X
AZ44289207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ145933Medicare PIN