Provider Demographics
NPI:1194790253
Name:GASIOREK, SCOTT A (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:GASIOREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3650 EMERGENCY LN
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5534
Practice Address - Country:US
Practice Address - Phone:863-382-8811
Practice Address - Fax:863-382-6055
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 444632085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43103OtherBCBS
FLP938830OtherOPTIMUM
FLP997942OtherFREEDOM
FL1249228OtherWELLCARE
FL1613633OtherCIGNA
FL4224437OtherAETNA
FL044174100Medicaid
FL337674OtherAVMED
FLP01572579OtherRR MEDICARE
FL044174100Medicaid
FL1613633OtherCIGNA
FL43103SMedicare PIN