Provider Demographics
NPI:1700030178
Name:SCHLAUDER, SCOTT M (MD MS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:SCHLAUDER
Suffix:
Gender:M
Credentials:MD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3400
Mailing Address - Country:US
Mailing Address - Phone:888-578-3188
Mailing Address - Fax:407-264-8955
Practice Address - Street 1:4545 PLEASANT HILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3400
Practice Address - Country:US
Practice Address - Phone:888-578-3188
Practice Address - Fax:407-264-8955
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106835207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL148N8OtherBLUE CROSS BLUE SHIELD
FLFB867XMedicare PIN