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General NPI Number Information
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NPI Number | 1699989301
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Entity Type | Organization
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Legal Business Name | SCOTT BEALS DO PA
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 4566 E HIGHWAY 20 SUITE 101
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City | NICEVILLE
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State | FL
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Zip | 32578-8838
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Country | US
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Telephone | 850-897-7546
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Fax | 850-897-7547
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Provider Business Mailing Address
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Address Line | 4566 E HIGHWAY 20 SUITE 101
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City | NICEVILLE
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State | FL
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Zip | 32578-8838
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Country | US
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Telephone | 850-897-7546
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Fax | 850-897-7547
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SCOTT L. BEALS
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Credential | D.O.
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Telephone | 850-897-7546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | OS7143
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License Number State | FL
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