Provider Demographics
NPI:1487763108
Name:M. SCOTT MAJOR M.D.
Entity type:Organization
Organization Name:M. SCOTT MAJOR M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MAJOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-866-0170
Mailing Address - Street 1:5896 S RIDGELINE DR STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4928
Mailing Address - Country:US
Mailing Address - Phone:801-866-0170
Mailing Address - Fax:801-866-0169
Practice Address - Street 1:5896 S RIDGELINE DR STE B
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4928
Practice Address - Country:US
Practice Address - Phone:801-866-0170
Practice Address - Fax:801-866-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4889252-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528370145006Medicaid
UTH04335Medicare UPIN
UT000012646Medicare ID - Type Unspecified