Healthcare Provider Details

I. General information

NPI: 1487675385
Provider Name (Legal Business Name): SCOTT GILES P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W CENTRAL PKWY SUITE 2000
ALTAMONTE SPRINGS FL
32714-2436
US

IV. Provider business mailing address

450 W CENTRAL PKWY SUITE 2000
ALTAMONTE SPRINGS FL
32714-2436
US

V. Phone/Fax

Practice location:
  • Phone: 407-767-8554
  • Fax: 407-767-9121
Mailing address:
  • Phone: 407-767-8554
  • Fax: 407-767-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: