Provider Demographics
NPI:1710912084
Name:COMITER, SCOTT LANCE (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LANCE
Last Name:COMITER
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 1:50 E SAMPLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3552
Mailing Address - Country:US
Mailing Address - Phone:954-784-7204
Mailing Address - Fax:954-784-7205
Practice Address - Street 1:50 E SAMPLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3552
Practice Address - Country:US
Practice Address - Phone:954-784-7204
Practice Address - Fax:954-784-7205
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 61855208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
18099AMedicare ID - Type Unspecified
F40850Medicare UPIN