Healthcare Provider Details

I. General information

NPI: 1801038070
Provider Name (Legal Business Name): SCOTT VON LARSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MEDICAL PARK DR STE 490
TAMPA FL
33613-6600
US

IV. Provider business mailing address

4571 COLONIAL BLVD
FORT MYERS FL
33966-1156
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-2470
  • Fax: 813-971-2491
Mailing address:
  • Phone: 239-333-0772
  • Fax: 239-244-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number145087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: