Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0102201920 | VA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 0102201920 | VA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 02323 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | DO 458 | AL |
NPI | 1164698213 |
---|---|
Provider Name | John Peter Scanlon |
First Address | Virginia Beach, VA 23471-8356 |
Second Address | Virginia Beach, VA 23462-6722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2008 |
Last Update Date | 08/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64058597 | (05) | KY |
F66217 | (02) | KY |