Provider Demographics
NPI:1164414884
Name:SCOTT, ERIC W (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:W
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 W NEWBERRY RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4381
Mailing Address - Country:US
Mailing Address - Phone:352-332-0030
Mailing Address - Fax:352-332-0039
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:SUITE 401
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-332-0030
Practice Address - Fax:352-332-0039
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044822207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0071OtherMEDICARE PTAN
FL008594600Medicaid
FL25187KMedicare ID - Type Unspecified
FL1311340001Medicare NSC
FLK0071OtherMEDICARE PTAN