Provider Demographics
NPI:1851437164
Name:SCOTT, CLARENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:
Last Name:SCOTT
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 1:931 VIHLEN RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7736
Mailing Address - Country:US
Mailing Address - Phone:407-491-5230
Mailing Address - Fax:407-324-4694
Practice Address - Street 1:1061 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8200
Practice Address - Country:US
Practice Address - Phone:386-917-5547
Practice Address - Fax:386-917-5569
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2742845Medicaid
FL2742845Medicaid
FLC63949Medicare UPIN