MEDICARE: SCOTT P. BRODY, M.D., PA

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	207V00000X	Obstetrics & Gynecology Physician	ME69231	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00395604	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27848	OTHER	FL	BLUE CROSS AND BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568780302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT P. BRODY, M.D., PA

Provider Business Mailing Address
First Line	:	11798 SAN JOSE BLVD
Second Line	:	SUITE 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1836
Country	:	US
Telephone Number	:	904-260-9808
Fax Number	:	904-260-2770

Provider Business Practice Location Address
First Line	:	11798 SAN JOSE BLVD
Second Line	:	SUITE 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1836
Country	:	US
Telephone Number	:	904-260-9808
Fax Number	:	904-260-2770

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SCOTT PHILIP BRODY
Credential	:	M.D.
Telephone Number	:	904-260-9808

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	08/04/2010

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Directions to “SCOTT P. BRODY, M.D., PA ” Practice Location

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