Provider Demographics
NPI:1639115801
Name:DUNAVANT, SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:DUNAVANT
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 1:14607 SUMMER ROSE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-6961
Mailing Address - Country:US
Mailing Address - Phone:859-806-7593
Mailing Address - Fax:
Practice Address - Street 1:695 TARPON BAY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-3137
Practice Address - Country:US
Practice Address - Phone:239-312-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109424207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64038938Medicaid
KY0245122Medicare ID - Type Unspecified
KY64038938Medicaid