Provider Demographics
NPI:1619917838
Name:DALY, SCOTT FITZGERALD (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:FITZGERALD
Last Name:DALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2876
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-2876
Mailing Address - Country:US
Mailing Address - Phone:229-891-9131
Mailing Address - Fax:
Practice Address - Street 1:3 HOSPITAL PARK
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6772
Practice Address - Country:US
Practice Address - Phone:229-891-3325
Practice Address - Fax:229-890-8702
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61510207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408966900Medicaid
MD014829S59Medicare ID - Type Unspecified
MDI15697Medicare UPIN