Provider Demographics
NPI:1265625313
Name:KANE, SCOTT L (PA-C)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:KANE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 METRO PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9462
Mailing Address - Country:US
Mailing Address - Phone:239-223-2751
Mailing Address - Fax:239-673-9102
Practice Address - Street 1:4310 METRO PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9462
Practice Address - Country:US
Practice Address - Phone:239-223-2751
Practice Address - Fax:239-673-9102
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-004665363A00000X
FLPA9110199363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2138902Medicare Oscar/Certification
VA2138902Medicare UPIN
VA2138902Medicare PIN
VA2138902Medicare PIN