Healthcare Provider Details

I. General information

NPI: 1134514573
Provider Name (Legal Business Name): SCOTT D MCDOWALL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PL SUITE 206
ST AUGUSTINE FL
32086-5774
US

IV. Provider business mailing address

PO BOX 840162
ST AUGUSTINE FL
32080-0162
US

V. Phone/Fax

Practice location:
  • Phone: 904-547-2808
  • Fax: 904-679-3169
Mailing address:
  • Phone: 904-540-9511
  • Fax: 904-679-3169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME104843
License Number StateFL

VIII. Authorized Official

Name: SCOTT MCDOWALL
Title or Position: OWNER
Credential: MD
Phone: 904-540-9511