Provider Demographics
NPI:1992791941
Name:FAUTH, SCOTT T (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:FAUTH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:4131 UNIVERSITY BLVD S
Mailing Address - Street 2:#16
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4326
Mailing Address - Country:US
Mailing Address - Phone:904-733-7408
Mailing Address - Fax:904-733-7668
Practice Address - Street 1:4131 UNIVERSITY BLVD S
Practice Address - Street 2:#16
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4326
Practice Address - Country:US
Practice Address - Phone:904-733-7408
Practice Address - Fax:904-733-7668
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0038362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15657OtherBCBS OF FL
FLD52686Medicare UPIN