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General NPI Number Information
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NPI Number | 1679122907
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Entity Type | Individual
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Provider Name | MR. SCOT JOSEPH POPPELL
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Gender | Male
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 1670 ST VINCENTS WAY
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City | MIDDLEBURG
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State | FL
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Zip | 32068-8447
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Country | US
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Telephone | 904-602-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 4392 FOREST EDGE CT
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City | JACKSONVILLE
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State | FL
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Zip | 32224-9670
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Country | US
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Telephone | 850-849-1971
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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 | PAT9112464
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License Number State | FL
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