Provider Demographics
NPI:1861553513
Name:ARBAUGH, SCOTT JOHANN (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:JOHANN
Last Name:ARBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9979 WINGHAVEN BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3628
Mailing Address - Country:US
Mailing Address - Phone:636-695-4554
Mailing Address - Fax:636-695-3099
Practice Address - Street 1:9979 WINGHAVEN BLVD
Practice Address - Street 2:STE 202
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3628
Practice Address - Country:US
Practice Address - Phone:636-695-4554
Practice Address - Fax:636-695-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0787162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00110810Medicare PIN
260009149Medicare PIN
IL211318Medicare PIN
P00383388Medicare PIN