Provider Demographics
NPI:1700154168
Name:SCOTT G KANTOR M.D. INC
Entity Type:Organization
Organization Name:SCOTT G KANTOR M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-375-7740
Mailing Address - Street 1:576 HARTNELL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2833
Mailing Address - Country:US
Mailing Address - Phone:831-375-7740
Mailing Address - Fax:
Practice Address - Street 1:576 HARTNELL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2833
Practice Address - Country:US
Practice Address - Phone:831-375-7740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG080215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE76247Medicare UPIN