Provider Demographics
NPI:1871964379
Name:ROYER, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:ROYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12324 S COUNTY ROAD 300 E
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47427-8935
Mailing Address - Country:US
Mailing Address - Phone:812-875-8866
Mailing Address - Fax:812-875-2045
Practice Address - Street 1:118 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47471-1712
Practice Address - Country:US
Practice Address - Phone:812-821-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-10
Last Update Date:2015-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24005869A174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian