1720063837 NPI number — SCOTT F DUNCAN V MD, MPH

Table of content: SCOTT F DUNCAN V MD, MPH (NPI 1720063837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720063837 NPI number — SCOTT F DUNCAN V MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNCAN
Provider First Name:
SCOTT
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
V
Provider Credential Text:
MD, MPH
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:
1720063837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 DOUG WHITE DR STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29572-4120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-848-1440
Provider Business Mailing Address Fax Number:
843-839-1654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 DOUG WHITE DR STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29572-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-848-1440
Provider Business Practice Location Address Fax Number:
843-839-1654
Provider Enumeration Date:
12/12/2005

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: 207X00000X , with the licence number:  51225 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 053610000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200042683 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2168452 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 625303 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02777223 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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