Provider Demographics
NPI:1033373980
Name:PERRIN, SCOTT DANA GUSTAFSON (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DANA GUSTAFSON
Last Name:PERRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:D
Other - Last Name:PERRIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1728 HANSEN ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3518
Mailing Address - Country:US
Mailing Address - Phone:813-382-3588
Mailing Address - Fax:941-552-5500
Practice Address - Street 1:1801 S OSPREY AVE STE 100
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3601
Practice Address - Country:US
Practice Address - Phone:941-552-5500
Practice Address - Fax:941-552-5501
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1055322085R0202X, 2085R0204X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program