Healthcare Provider Details

I. General information

NPI: 1164421186
Provider Name (Legal Business Name): SCOTT ALLEN FRENCH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 STATE ROAD 674
WIMAUMA FL
33598-3515
US

IV. Provider business mailing address

5121 STATE ROAD 674
WIMAUMA FL
33598-3515
US

V. Phone/Fax

Practice location:
  • Phone: 813-633-8489
  • Fax: 813-633-2669
Mailing address:
  • Phone: 813-633-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9100944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: