Provider Demographics
NPI:1790175842
Name:SCOTT L DUNAVANT MD, INC
Entity Type:Organization
Organization Name:SCOTT L DUNAVANT MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNAVANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-278-1155
Mailing Address - Street 1:695 TARPON BAY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-3137
Mailing Address - Country:US
Mailing Address - Phone:239-312-4544
Mailing Address - Fax:239-278-1159
Practice Address - Street 1:695 TARPON BAY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-3137
Practice Address - Country:US
Practice Address - Phone:239-312-4544
Practice Address - Fax:239-278-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109424207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME109424OtherMEDICAL LICENSE