Healthcare Provider Details

I. General information

NPI: 1629077318
Provider Name (Legal Business Name): LUIS EDUARDO SCACCABARROZZI MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LUIS E SCACCABARROZZI MD, MPH

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 W NEWBERRY RD SUITE 105
GAINESVILLE FL
32605-4381
US

IV. Provider business mailing address

6400 W NEWBERRY RD STE 109
GAINESVILLE FL
32605-4388
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-4400
  • Fax: 352-332-0086
Mailing address:
  • Phone: 352-332-4400
  • Fax: 352-332-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2006001810
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME90127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: