Healthcare Provider Details

I. General information

NPI: 1942232566
Provider Name (Legal Business Name): SCOTT C BRADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N LAKE DESTINY RD SUITE 400
MAITLAND FL
32751-4844
US

IV. Provider business mailing address

901 N LAKE DESTINY RD SUITE 400
MAITLAND FL
32751-4844
US

V. Phone/Fax

Practice location:
  • Phone: 407-200-2860
  • Fax: 407-200-1365
Mailing address:
  • Phone: 407-200-2860
  • Fax: 407-200-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 57207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: