Healthcare Provider Details

I. General information

NPI: 1700812385
Provider Name (Legal Business Name): SCOTT A GROAT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S MARY ESTHER BLVD STE 510
MARY ESTHER FL
32569-1972
US

IV. Provider business mailing address

151 S MARY ESTHER BLVD SUITE 510
MARY ESTHER FL
32569-1972
US

V. Phone/Fax

Practice location:
  • Phone: 850-243-1255
  • Fax: 850-664-5578
Mailing address:
  • Phone: 850-243-1255
  • Fax: 850-664-5578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO 1786
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: