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General NPI Number Information
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NPI Number | 1548293558
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Entity Type | Individual
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Provider Name | SCOTT D POAG PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 89 W COPELAND DR
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City | ORLANDO
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State | FL
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Zip | 32806-2002
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Country | US
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Telephone | 321-841-7550
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Fax | 321-841-8185
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER DR
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City | LEBANON
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State | NH
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Zip | 03756-0001
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Country | US
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Telephone | 603-650-5000
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | EL11614
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA 9102866
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00783100
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License Number State | NJ
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