Provider Demographics
NPI:1376514406
Name:PHILLIPS, SCOTT D (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:PHILLIPS
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:PO BOX 13250
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:WA
Mailing Address - Zip Code:98013-0250
Mailing Address - Country:US
Mailing Address - Phone:303-815-1960
Mailing Address - Fax:303-889-5161
Practice Address - Street 1:730 17TH ST
Practice Address - Street 2:SUITE 925
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-3580
Practice Address - Country:US
Practice Address - Phone:303-815-1960
Practice Address - Fax:303-889-5161
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30404174400000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78133718Medicaid
CO1304047Medicaid
CO78133718Medicaid
CO1304047Medicaid
CO532048Medicare ID - Type UnspecifiedGROUP