Provider Demographics
NPI:1427389691
Name:GLADSTONE, SCOTT BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BRUCE
Last Name:GLADSTONE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:75-5915 WALUA RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1375
Mailing Address - Country:US
Mailing Address - Phone:808-329-7774
Mailing Address - Fax:
Practice Address - Street 1:1225 W 190TH ST STE 280
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4305
Practice Address - Country:US
Practice Address - Phone:310-515-8113
Practice Address - Fax:310-538-2102
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD78412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry