Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 036088435 | IL |
N | 208800000X | Urologist | 175031 | NY |
N | 208800000X | Urologist | G88428 | CA |
Y | 208800000X | Urologist | ME103036 | FL |
NPI | 1003880626 |
---|---|
Provider Name | Dr. Bennett Peter Scaglia |
First Address | Daytona Beach, FL 32114-2766 |
Second Address | Daytona Beach, FL 32114-2781 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 27/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
.36088435 | (05) | IL |
000954100 | (05) | FL |
5007705 | BLUE CROSS/BLUE SHIELD IL (01) | IL |
F78597 | (02) | FL |
F78597 | (02) | IL |