1114925146 NPI number — GERALD ALAN SCOTT II CRNA

Table of content: GERALD ALAN SCOTT II CRNA (NPI 1114925146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114925146 NPI number — GERALD ALAN SCOTT II CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
GERALD
Provider Middle Name:
ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114925146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1074
Provider Second Line Business Mailing Address:
C/O ANESTHESIA ASSOCIATES OF DUNEDIN
Provider Business Mailing Address City Name:
DUNEDIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34697-1074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-734-6516
Provider Business Mailing Address Fax Number:
727-734-4516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 MAIN ST
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
DUNEDIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34698-5848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-734-6516
Provider Business Practice Location Address Fax Number:
727-734-4516
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  ARNP 3292182 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G3552 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 120817700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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