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General NPI Number Information
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NPI Number | 1336074467
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Entity Type | Organization
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Legal Business Name | SCOCCOLO FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 06/18/2026
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 98 E LAKE MEAD PKWY STE 105
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City | HENDERSON
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State | NV
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Zip | 89015-6443
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Country | US
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Telephone | 702-823-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 1887 WHITNEY MESA DR # 4022
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City | HENDERSON
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State | NV
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Zip | 89014-2069
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Country | US
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Telephone | 702-823-4300
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Fax | 702-906-1844
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MR. ANTHONY THOMAS SCOCCOLO
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Credential | PA-C
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Telephone | 702-823-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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