Provider Demographics
NPI:1861423899
Name:PIETTE, SCOTT DOUGLAS (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DOUGLAS
Last Name:PIETTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:DOUGLAS
Other - Last Name:PIETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:509 SE RIVERSIDE DR STE 302
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2579
Mailing Address - Country:US
Mailing Address - Phone:772-287-9000
Mailing Address - Fax:
Practice Address - Street 1:509 SE RIVERSIDE DR STE 302
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2579
Practice Address - Country:US
Practice Address - Phone:772-287-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16827207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019759930003Medicaid
PAC12100OtherTRAVELERS MEDICARE
PA114601YH3HMedicare PIN
PAC12100OtherTRAVELERS MEDICARE
PA114601KHMMedicare PIN