Healthcare Provider Details

I. General information

NPI: 1467491357
Provider Name (Legal Business Name): SCOTT S KORMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 W UNDERWOOD ST MP 80
ORLANDO FL
32806-2008
US

IV. Provider business mailing address

86 W UNDERWOOD ST MP 80
ORLANDO FL
32806-2008
US

V. Phone/Fax

Practice location:
  • Phone: 888-912-3648
  • Fax: 321-841-4085
Mailing address:
  • Phone: 888-912-3648
  • Fax: 321-841-4085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME72575
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME72575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: