Provider Demographics
NPI:1922199843
Name:BLUMENTHAL, SCOTT EVAN (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EVAN
Last Name:BLUMENTHAL
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 1:1601 CLINT MOORE ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487
Mailing Address - Country:US
Mailing Address - Phone:561-939-0300
Mailing Address - Fax:561-939-0339
Practice Address - Street 1:1601 CLINT MOORE ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487
Practice Address - Country:US
Practice Address - Phone:561-939-0300
Practice Address - Fax:561-939-0339
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99446Medicare PIN
FLI16327Medicare UPIN
FL99446Medicare PIN