Provider Demographics
NPI:1508802752
Name:FREEMAN, SCOTT A (PAC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CARILLON PKWY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1115
Mailing Address - Country:US
Mailing Address - Phone:727-572-1333
Mailing Address - Fax:727-572-1331
Practice Address - Street 1:900 CARILLON PKWY STE 404
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1121
Practice Address - Country:US
Practice Address - Phone:727-572-1333
Practice Address - Fax:727-572-1331
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5981408011OtherCHAMPUS
FLE4349WMedicare PIN
FLE4349UMedicare PIN
FLE4349SMedicare PIN
FLE4349TMedicare PIN
FLP10461Medicare UPIN