Healthcare Provider Details

I. General information

NPI: 1265528319
Provider Name (Legal Business Name): JAMES M SCANLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 9TH ST N SUITE 120
NAPLES FL
34102-6224
US

IV. Provider business mailing address

130 9TH ST N SUITE 120
NAPLES FL
34102-6224
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-0550
  • Fax: 239-649-1785
Mailing address:
  • Phone: 239-649-0550
  • Fax: 239-649-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME105132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: