Provider Demographics
NPI:1841467362
Name:ANDERSON, SCOTT R (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:ANDERSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:SELECT PHYSICIANS ALLIANCE
Mailing Address - Street 2:10002 PRINCESS PALM AVE. STE 332
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-8327
Mailing Address - Country:US
Mailing Address - Phone:813-571-7184
Mailing Address - Fax:813-654-4695
Practice Address - Street 1:FLORIDA ENT & ALLERGY
Practice Address - Street 2:5105 N ARMENIA AVE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1405
Practice Address - Country:US
Practice Address - Phone:813-879-8045
Practice Address - Fax:813-876-6504
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2019-05-03
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Provider Licenses
StateLicense IDTaxonomies
FLME100639174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000333900Medicaid
FL333900Medicaid