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NPI 1487764940

NPI 1487764940 : JAMES BERNARD SCALZO PA-C : SEBRING, FL

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General NPI Number Information
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    NPI Number           |    1487764940
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    Entity Type          |    Individual 
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    Provider Name        |    JAMES BERNARD SCALZO PA-C
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    08/30/2006
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    3750 EMERGENCY LN SUITE 1
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    City                 |    SEBRING
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    State                |    FL
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    Zip                  |    33870-5500
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    Country              |    US
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    Telephone            |    863-471-1511
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    Fax                  |    863-471-1512
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Provider Business Mailing Address
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    Address Line         |    3750 EMERGENCY LN SUITE 1
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    City                 |    SEBRING
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    State                |    FL
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    Zip                  |    33870-5500
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    Country              |    US
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    Telephone            |    863-471-1511
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    Fax                  |    863-471-1512
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    363AM0700X
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    Taxonomy Name        |    Medical Physician Assistant
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    License Number       |    PA9103663
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    License Number State |    FL
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