MEDICARE: MICHAEL A. SCANNON MD 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	207NS0135X	Procedural Dermatology Physician	ME0029315	FL

General Provider Information

NPI Number	:	1841267895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL A. SCANNON MD PA

Provider Business Mailing Address
First Line	:	4200 N ARMENIA AVE
Second Line	:	SUITE 1
City	:	TAMPA
State	:	FL
Zip	:	33607-6438
Country	:	US
Telephone Number	:	813-877-4811
Fax Number	:	813-872-8978

Provider Business Practice Location Address
First Line	:	4200 N ARMENIA AVE
Second Line	:	SUITE 1
City	:	TAMPA
State	:	FL
Zip	:	33607-6438
Country	:	US
Telephone Number	:	813-877-4811
Fax Number	:	813-872-8978

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. MICHAEL ANTHONY SCANNON
Credential	:	MD
Telephone Number	:	813-877-4811

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	07/14/2010

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