Provider Demographics
NPI:1851305635
Name:KAZDAN, SCOTT D (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:KAZDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 N FLAMINGO RD
Mailing Address - Street 2:209
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1015
Mailing Address - Country:US
Mailing Address - Phone:954-442-7616
Mailing Address - Fax:954-442-6234
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:209
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-442-7616
Practice Address - Fax:954-442-6234
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0006354204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
57501AMedicare ID - Type Unspecified
G58895Medicare UPIN