Provider Demographics
NPI:1093799215
Name:KAISER, SCOTT D (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:KAISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 S YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2026
Mailing Address - Country:US
Mailing Address - Phone:303-721-9984
Mailing Address - Fax:303-267-7304
Practice Address - Street 1:7030 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2026
Practice Address - Country:US
Practice Address - Phone:303-721-9984
Practice Address - Fax:303-267-7304
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113073207P00000X
KS429027207P00000X
CO48397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86832816Medicaid
COCOA106761OtherMEDICARE PTAN
COCOA106761OtherMEDICARE PTAN
H30838Medicare UPIN
CO86832816Medicaid
MOR86A00007Medicare PIN