Provider Demographics
NPI:1649201153
Name:SCOLA, JERE ANTHONY III (MD)
Entity Type:Individual
Prefix:
First Name:JERE
Middle Name:ANTHONY
Last Name:SCOLA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 147050
Mailing Address - Street 2:PMB 515
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-7050
Mailing Address - Country:US
Mailing Address - Phone:352-264-0094
Mailing Address - Fax:352-377-4816
Practice Address - Street 1:4615 NW 53RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4885
Practice Address - Country:US
Practice Address - Phone:352-264-0094
Practice Address - Fax:352-375-1677
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02981213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340266500Medicaid
FL340266500Medicaid
FL65754Medicare ID - Type Unspecified