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NPI Code Detail

MEDICARE: SCOTT EARLE BOURNE M.D.

MEDICARE: SCOTT EARLE BOURNE M.D.
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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianMT 186362PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912149295
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT EARLE BOURNE M.D.
Provider Business Mailing Address
First Line : 4088 REDBUD CIR
Second Line :
City : DOYLESTOWN
State : PA
Zip : 18902-8821
Country : US
Telephone Number : 267-337-1760
Fax Number :
Provider Business Practice Location Address
First Line : 4665 PONCE DE LEON BLVD
Second Line :
City : CORAL GABLES
State : FL
Zip : 33146-2101
Country : US
Telephone Number : 786-268-6050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2009
Last Update Date : 12/03/2013

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