Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME29315 | FL |
Y | 207NS0135X | Procedural Dermatology | ME00029315 | FL |
NPI | 1396734851 |
---|---|
Provider Name | Dr. Michael A Scannon |
First Address | Tampa, FL 33607-6438 |
Second Address | Tampa, FL 33607-6438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 09/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
372329100 | (05) | FL |
D55968 | (02) | FL |