Provider Demographics
NPI:1629077318
Name:SCACCABARROZZI, LUIS EDUARDO (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:EDUARDO
Last Name:SCACCABARROZZI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:E
Other - Last Name:SCACCABARROZZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:6400 W NEWBERRY RD STE 109
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4388
Mailing Address - Country:US
Mailing Address - Phone:352-332-4400
Mailing Address - Fax:352-332-0086
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-332-4400
Practice Address - Fax:352-332-0086
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006001810208000000X
FLME90127208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269442500Medicaid
FL1629077318OtherNPI