Provider Demographics
NPI:1174649396
Name:SCOFIELD, GARY (PA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:SCOFIELD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200 WEST
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:972-364-8000
Mailing Address - Fax:
Practice Address - Street 1:20 W DRY CREEK CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4478
Practice Address - Country:US
Practice Address - Phone:303-798-1009
Practice Address - Fax:303-798-1324
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10334363A00000X
CO4258363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABX506ZMedicare UPIN
CAZZZ07334ZMedicare PIN