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Individual

DR. SCOTT A. TETREAULT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2351 PHILLIPS RD, TALLAHASSEE, FL 32308-5333
(850) 877-8166
(850) 877-0431
Mailing address
PO BOX 102222, ATLANTA, GA 30368-2222
(239) 274-8200
(239) 278-3550

Taxonomy

Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
ME65204
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
256881100
FL
01
830005937
RR MEDICARE
FL
Enumeration date
11/29/2005
Last updated
09/02/2022
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