Healthcare Provider Details

I. General information

NPI: 1639115801
Provider Name (Legal Business Name): SCOTT DUNAVANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 TARPON BAY RD SUITE 2
SANIBEL FL
33957-3137
US

IV. Provider business mailing address

14607 SUMMER ROSE WAY
FORT MYERS FL
33919-6961
US

V. Phone/Fax

Practice location:
  • Phone: 239-312-4544
  • Fax:
Mailing address:
  • Phone: 859-806-7593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME109424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: