Healthcare Provider Details

I. General information

NPI: 1841267895
Provider Name (Legal Business Name): MICHAEL A. SCANNON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 N ARMENIA AVE SUITE 1
TAMPA FL
33607-6438
US

IV. Provider business mailing address

4200 N ARMENIA AVE SUITE 1
TAMPA FL
33607-6438
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-4811
  • Fax: 813-872-8978
Mailing address:
  • Phone: 813-877-4811
  • Fax: 813-872-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME0029315
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL ANTHONY SCANNON
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 813-877-4811