Healthcare Provider Details

I. General information

NPI: 1427016203
Provider Name (Legal Business Name): JEFFREY M SCOTT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NW 10TH AVE
MIAMI FL
33136-1015
US

IV. Provider business mailing address

1600 NW 10TH AVE
MIAMI FL
33136-1015
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6372
  • Fax:
Mailing address:
  • Phone: 305-243-6372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS8572
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberTP401
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberOS8572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: