Individual
DR. BENNETT PETER SCAGLIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
311 N CLYDE MORRIS BLVD, SUITE 360, DAYTONA BEACH, FL 32114-2781
(386) 254-4199
(386) 947-4680
Mailing address
311 N CLYDE MORRIS BLVD STE 480, DAYTONA BEACH, FL 32114-2766
(386) 425-4199
(386) 425-4680
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
036088435
IL
208800000X
Urology Physician
175031
NY
208800000X
Urology Physician
G88428
CA
208800000X
Urology Physician
Primary
ME103036
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
.36088435
—
IL
05
—
000954100
—
FL
01
—
5007705
BLUE CROSS/BLUE SHIELD IL
IL
Enumeration date
02/13/2006
Last updated
04/27/2020
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