=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194907378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLARENCE SCOTT MD,PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2007
-----------------------------------------------------
Last Update Date | 01/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1621 W FIRST STREET
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32772-0907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-345-8961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 907 1621 W.FIRST STREET
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32772-0907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-345-8961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. CLARENCE SCOTT
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 407-351-1809
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME0059756
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------