Provider Demographics
NPI:1053535765
Name:SCOTT, GREGORY JAY (HIS)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JAY
Last Name:SCOTT
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 ALAMO HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4504
Mailing Address - Country:US
Mailing Address - Phone:210-688-6117
Mailing Address - Fax:
Practice Address - Street 1:426 ALAMO HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4504
Practice Address - Country:US
Practice Address - Phone:210-688-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50393237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist