Basic Information
| Provider Information | |||||||||
| NPI: | 1841267895 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MICHAEL A. SCANNON MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 N ARMENIA AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138774811 | ||||||||
| FaxNumber: | 8138728978 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 N ARMENIA AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138774811 | ||||||||
| FaxNumber: | 8138728978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 07/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | SCANNON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8138774811 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207NS0135X | ME0029315 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
No ID Information.