Provider Demographics
NPI:1730495698
Name:SCOTT A GROAT D P M P A
Entity Type:Organization
Organization Name:SCOTT A GROAT D P M P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GROAT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:850-243-1255
Mailing Address - Street 1:151 MARY ESTHER BLVD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1972
Mailing Address - Country:US
Mailing Address - Phone:850-243-1255
Mailing Address - Fax:850-664-5578
Practice Address - Street 1:151 MARY ESTHER BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1972
Practice Address - Country:US
Practice Address - Phone:850-243-1255
Practice Address - Fax:850-664-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-28
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1786213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029673200Medicaid
FLT84664Medicare UPIN
FL029673200Medicaid