Provider Demographics
NPI:1982674446
Name:FAYNE, SCOTT (MD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:FAYNE
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 1:4495 MILITARY TRL
Mailing Address - Street 2:204
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4839
Mailing Address - Country:US
Mailing Address - Phone:561-296-1122
Mailing Address - Fax:561-296-5566
Practice Address - Street 1:4495 MILITARY TRL
Practice Address - Street 2:204
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4839
Practice Address - Country:US
Practice Address - Phone:561-296-1122
Practice Address - Fax:561-296-5566
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049442207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D50640Medicare UPIN
FL02772Medicare PIN