Provider Demographics
NPI:1942232566
Name:BRADY, SCOTT C (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:BRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N LAKE DESTINY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4844
Mailing Address - Country:US
Mailing Address - Phone:407-200-2860
Mailing Address - Fax:407-200-1365
Practice Address - Street 1:901 N LAKE DESTINY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4844
Practice Address - Country:US
Practice Address - Phone:407-200-2860
Practice Address - Fax:407-200-1365
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 57207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE60461Medicare UPIN