| Entity Name: | SCOTT L DUNAVANT MD, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 16 May 2014 (11 years ago) |
| Document Number: | P14000044346 |
| FEI/EIN Number | 46-5672218 |
| Address: | 14607 SUMMER ROSE WAY, FORT MYERS, FL 33919 |
| Mail Address: | 14607 Summer Rose Way, Fort Myers, FL 33919 |
| ZIP code: | 33919 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790175842 | 2015-01-28 | 2017-02-08 | 695 TARPON BAY RD, SUITE 2, SANIBEL, FL, 339573137, US | 695 TARPON BAY RD, SUITE 2, SANIBEL, FL, 339573137, US | |||||||||||||||||||||||||
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| Phone | +1 239-312-4544 |
| Fax | 2392781159 |
Authorized person
| Name | SCOTT L DUNAVANT |
| Role | OWNER |
| Phone | 2392781155 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| License Number | ME109424 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | ME109424 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPIN-OFF TERMINATION PLAN FOR SCOTT L. DUNAVANT MD, INC. | 2018 | 465672218 | 2019-07-13 | SCOTT L. DUNAVANT MD, INC. | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2019-07-13 |
| Name of individual signing | SHERYL SOUTHWICK |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-10-30 |
| Business code | 541214 |
| Sponsor’s telephone number | 2393124544 |
| Plan sponsor’s address | 695 TARPON BAY RD. SUITE 2, SANIBEL, FL, 33957 |
Signature of
| Role | Plan administrator |
| Date | 2019-08-21 |
| Name of individual signing | SHERYL SOUTHWICK |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| DUNAVANT, SCOTT L | Agent | 14607 Summer Rose Way, Fort Myers, FL 33919 |
| Name | Role | Address |
|---|---|---|
| DUNAVANT, SCOTT L | President | 14607 Summer Rose Way, Fort Myers, FL 33919 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000053097 | DUNAVANT MEDICAL GROUP | ACTIVE | 2015-06-01 | 2025-12-31 | No data | 14607 SUMMER ROSE WAY, FORT MYERS,, FL, 33919 |
| G15000026761 | DUNAVANT MEDICAL GROUP | EXPIRED | 2015-03-13 | 2020-12-31 | No data | 1314 ISABEL DRIVE, SANIBEL, FL, 33957 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-11-02 | 14607 SUMMER ROSE WAY, FORT MYERS, FL 33919 | No data |
| CHANGE OF MAILING ADDRESS | 2018-07-15 | 14607 SUMMER ROSE WAY, FORT MYERS, FL 33919 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-07-15 | 14607 Summer Rose Way, Fort Myers, FL 33919 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-02 |
| ANNUAL REPORT | 2024-02-22 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-16 |
| ANNUAL REPORT | 2021-02-18 |
| ANNUAL REPORT | 2020-04-17 |
| ANNUAL REPORT | 2019-04-22 |
| ANNUAL REPORT | 2018-07-15 |
| ANNUAL REPORT | 2017-03-26 |
| ANNUAL REPORT | 2016-03-26 |
Date of last update: 20 Feb 2025
Sources: Florida Department of State
