Provider Demographics
NPI:1760403463
Name:MEDLEY, E SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:E
Middle Name:SCOTT
Last Name:MEDLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EVAN
Other - Middle Name:SCOTT
Other - Last Name:MEDLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-4541
Practice Address - Fax:352-332-7116
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D83955Medicare UPIN
01262YMedicare PIN