Provider Demographics
NPI:1881655561
Name:SCALZO, LAWRENCE JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:SCALZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 JACK DR
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3825
Mailing Address - Country:US
Mailing Address - Phone:321-747-4322
Mailing Address - Fax:
Practice Address - Street 1:334 JACK DR
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3825
Practice Address - Country:US
Practice Address - Phone:321-747-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGZ195YMedicare PIN
MSB30368Medicare UPIN
MS080002622Medicare ID - Type Unspecified