Provider Demographics
NPI:1023081254
Name:KUTZ, SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:KUTZ
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 1:5425 W SPRING CREEK PKWY STE 133
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4334
Mailing Address - Country:US
Mailing Address - Phone:972-244-3491
Mailing Address - Fax:972-535-2181
Practice Address - Street 1:5425 W SPRING CREEK PKWY STE 133
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-244-3491
Practice Address - Fax:972-535-2181
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005007061207T00000X
TXQ8094207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1023081254Medicaid
P00653954OtherRAILROAD MEDICARE -SJC
TN1516369Medicaid
MOP00254599OtherRAILROAD MEDICARE
MO1023081254Medicaid
P00653954OtherRAILROAD MEDICARE -SJC
MO935883572Medicare ID - Type Unspecified
MO132300099Medicare PIN