Provider Demographics
NPI:1447551346
Name:MIDDLEKAUFF, SCOTT ALAN (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:MIDDLEKAUFF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 BONAVENTURE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5813
Mailing Address - Country:US
Mailing Address - Phone:202-744-0534
Mailing Address - Fax:
Practice Address - Street 1:7033 BONAVENTURE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5813
Practice Address - Country:US
Practice Address - Phone:202-744-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004202363A00000X
PAMA000302L363A00000X
FL9105904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant