MEDICARE: SCOTT M LABOHN D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO0002591	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65516	OTHER	FL	BLUE CROSS BLUE SHIELD
2	2700469	OTHER	FL	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1396722898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT M LABOHN D.P.M.

Provider Business Mailing Address
First Line	:	2835 W DE LEON ST
Second Line	:	SUITE 101
City	:	TAMPA
State	:	FL
Zip	:	33609-4168
Country	:	US
Telephone Number	:	813-254-6592
Fax Number	:	813-254-3634

Provider Business Practice Location Address
First Line	:	38105 13TH AVE
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-3437
Country	:	US
Telephone Number	:	813-715-4747
Fax Number	:	813-783-8937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	07/11/2011

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Directions to “ SCOTT M LABOHN D.P.M.” Practice Location

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