Provider Demographics
NPI:1982829982
Name:MCDOWALL, SCOTT D (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:MCDOWALL
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:PO BOX 840162
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-0162
Mailing Address - Country:US
Mailing Address - Phone:904-429-9892
Mailing Address - Fax:904-217-7631
Practice Address - Street 1:100 WHETSTONE PL
Practice Address - Street 2:SUITE 206
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5774
Practice Address - Country:US
Practice Address - Phone:904-429-9892
Practice Address - Fax:904-217-7631
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104843207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1466ZOtherBCBS
FL001091400Medicaid
FLP00407138OtherRR MEDICARE
FLP00407138OtherRR MEDICARE
FL1466ZOtherBCBS