Provider Demographics
NPI:1700812385
Name:GROAT, SCOTT A (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:GROAT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S MARY ESTHER BLVD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1972
Mailing Address - Country:US
Mailing Address - Phone:850-243-1255
Mailing Address - Fax:850-664-5578
Practice Address - Street 1:151 S MARY ESTHER BLVD
Practice Address - Street 2:STE 510
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1972
Practice Address - Country:US
Practice Address - Phone:850-243-1255
Practice Address - Fax:850-664-5578
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1786213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029673200Medicaid
FL4702940001Medicare NSC
FLT84664Medicare UPIN
FL029673200Medicaid