Provider Demographics
NPI:1023047909
Name:PATTISON, SCOTT THOMAS (DPM)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:PATTISON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S AUSTIN AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7545
Mailing Address - Country:US
Mailing Address - Phone:512-930-3338
Mailing Address - Fax:512-930-3009
Practice Address - Street 1:3201 S AUSTIN AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7545
Practice Address - Country:US
Practice Address - Phone:512-930-3338
Practice Address - Fax:512-930-3099
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1368213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A2741OtherBLUECROSS/BLUESHIELD
TX112181602Medicaid
TX8A2741OtherBLUECROSS/BLUESHIELD
TXU66468Medicare UPIN
TX112181602Medicaid