Provider Demographics
NPI:1992894414
Name:CRATER, SCOTT E (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:CRATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8381 RIVERWALK PARK BLVD. UNIT101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8757
Mailing Address - Country:US
Mailing Address - Phone:239-936-5425
Mailing Address - Fax:239-936-5176
Practice Address - Street 1:8381 RIVERWALK PARK BLVD. UNIT101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8757
Practice Address - Country:US
Practice Address - Phone:239-936-5425
Practice Address - Fax:239-936-5176
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH82508Medicare UPIN