Provider Demographics
NPI:1346395985
Name:VINCENT, SCOTT E (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:VINCENT
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 1:601 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2041
Mailing Address - Country:US
Mailing Address - Phone:970-263-7348
Mailing Address - Fax:970-241-1674
Practice Address - Street 1:601 CENTER AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2041
Practice Address - Country:US
Practice Address - Phone:970-263-7348
Practice Address - Fax:970-241-1674
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33850207Q00000X, 2086S0129X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1338508Medicaid
CO92451Medicare ID - Type Unspecified
CO807401Medicare PIN
F85243Medicare UPIN