Healthcare Provider Details

I. General information

NPI: 1497754725
Provider Name (Legal Business Name): SCOTT ALLEN SANFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 S US HIGHWAY 1
FORT PIERCE FL
34982-8701
US

IV. Provider business mailing address

5550 S US HIGHWAY 1
FORT PIERCE FL
34982-8701
US

V. Phone/Fax

Practice location:
  • Phone: 772-460-9227
  • Fax: 772-460-9292
Mailing address:
  • Phone: 772-460-9227
  • Fax: 772-460-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME63841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: