Provider Demographics
NPI:1679535918
Name:MOFFITT, SCOTT A (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:MOFFITT
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 1:134 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5402
Mailing Address - Country:US
Mailing Address - Phone:561-842-4261
Mailing Address - Fax:561-842-7481
Practice Address - Street 1:134 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5402
Practice Address - Country:US
Practice Address - Phone:561-842-4261
Practice Address - Fax:561-842-7481
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG48958Medicare UPIN
FL32904Medicare ID - Type Unspecified