Provider Demographics
NPI:1174518310
Name:CLULOW, SCOTT K (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:K
Last Name:CLULOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:5601 21ST AVE W
Practice Address - Street 2:#D
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5642
Practice Address - Country:US
Practice Address - Phone:941-313-7142
Practice Address - Fax:941-794-2805
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080185717OtherRAIL ROAD MEDICARE
FL62157OtherBCBS
FL264317100Medicaid
62157VMedicare PIN
FLH63795Medicare UPIN
FL62157UMedicare PIN