Provider Demographics
NPI:1831333269
Name:PIPER, SCOTT RICHARD (IDMT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:RICHARD
Last Name:PIPER
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 KINCHELOE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3333
Mailing Address - Country:US
Mailing Address - Phone:702-243-3337
Mailing Address - Fax:
Practice Address - Street 1:PSC 831
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09363-9998
Practice Address - Country:US
Practice Address - Phone:702-652-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians