Healthcare Provider Details

I. General information

NPI: 1710426846
Provider Name (Legal Business Name): ROBERT SCOTT PITCHFORD HAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S. AMELIA AVE. UNIT #B
DELAND FL
32724-5564
US

IV. Provider business mailing address

1751 BLUE RIDGE RD
WINTER PARK FL
32789-5826
US

V. Phone/Fax

Practice location:
  • Phone: 386-736-3322
  • Fax: 386-736-1133
Mailing address:
  • Phone: 407-601-5798
  • Fax: 407-286-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAST593
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: