Provider Demographics
NPI:1508800392
Name:TALBERT, SCOTT D (PA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:TALBERT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6050 CATTLERIDGE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6014
Mailing Address - Country:US
Mailing Address - Phone:941-365-0655
Mailing Address - Fax:941-366-8043
Practice Address - Street 1:6050 CATTLERIDGE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6014
Practice Address - Country:US
Practice Address - Phone:941-365-0655
Practice Address - Fax:941-366-8043
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102142363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8546UMedicare ID - Type UnspecifiedMEDICARE NUMBER