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General NPI Number Information
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NPI Number | 1841228004
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Entity Type | Individual
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Provider Name | BRIAN E. SCANLAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 2330 UTAH AVE STE 200
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City | EL SEGUNDO
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State | CA
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Zip | 90245-4817
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Country | US
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Telephone | 281-766-0959
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Fax |
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Provider Business Mailing Address
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Address Line | 17720 GULF BLVD APT 704
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City | REDINGTON SHORES
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State | FL
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Zip | 33708-4271
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Country | US
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Telephone | 727-512-3458
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Fax | 727-559-0594
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME83395
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License Number State | FL
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