Provider Demographics
NPI:1508810854
Name:BECKSTEAD, SCOTT H (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:H
Last Name:BECKSTEAD
Suffix:
Gender:M
Credentials:DO
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 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:801-992-3365
Mailing Address - Fax:
Practice Address - Street 1:390 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6046
Practice Address - Country:US
Practice Address - Phone:801-294-1000
Practice Address - Fax:801-292-8369
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56903741204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854057086Medicaid
UT000063160Medicare PIN
UTI22746Medicare UPIN