Provider Demographics
NPI:1912000464
Name:BEALS, SCOTT L (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:BEALS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4566 E HIGHWAY 20
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-8838
Mailing Address - Country:US
Mailing Address - Phone:850-897-7546
Mailing Address - Fax:850-897-7547
Practice Address - Street 1:4566 E HIGHWAY 20
Practice Address - Street 2:SUITE 101
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8838
Practice Address - Country:US
Practice Address - Phone:850-897-7546
Practice Address - Fax:850-897-7547
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2014-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7143207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13586YOtherFLORIDA MEDICARE PTAN #
FL266706100Medicaid
FLH62236Medicare UPIN