Healthcare Provider Details

I. General information

NPI: 1790175842
Provider Name (Legal Business Name): SCOTT L DUNAVANT MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 02/08/2017
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

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

V. Phone/Fax

Practice location:
  • Phone: 239-312-4544
  • Fax: 239-278-1159
Mailing address:
  • Phone: 239-312-4544
  • Fax: 239-278-1159

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: SCOTT L DUNAVANT
Title or Position: OWNER
Credential: MD
Phone: 239-278-1155