Provider Demographics
NPI:1700278710
Name:FAIR, SCOTT M (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:FAIR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PALM LAKES BLVD
Mailing Address - Street 2:400
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6504
Mailing Address - Country:US
Mailing Address - Phone:561-500-2020
Mailing Address - Fax:
Practice Address - Street 1:2000 PALM BEACH LAKES BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6504
Practice Address - Country:US
Practice Address - Phone:561-561-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14637207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist