Provider Demographics
NPI:1861211302
Name:SCOTT, ANTOINE JEROME
Entity type:Individual
Prefix:
First Name:ANTOINE
Middle Name:JEROME
Last Name:SCOTT
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 1:321 W NORMAN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-3344
Mailing Address - Country:US
Mailing Address - Phone:937-344-2168
Mailing Address - Fax:
Practice Address - Street 1:215 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2103
Practice Address - Country:US
Practice Address - Phone:937-344-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist