Provider Demographics
NPI:1588665830
Name:RICKOFF, SCOTT ELLIOT (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ELLIOT
Last Name:RICKOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N PALAFOX ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1721
Mailing Address - Country:US
Mailing Address - Phone:850-433-5488
Mailing Address - Fax:850-434-9088
Practice Address - Street 1:2110 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1721
Practice Address - Country:US
Practice Address - Phone:850-433-5488
Practice Address - Fax:850-434-9088
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01096213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041084500Medicaid
T95160Medicare UPIN
FL041084500Medicaid