Provider Demographics
NPI:1851376347
Name:ANDERSEN, SCOTT R (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:ANDERSEN
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 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10240 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5425
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO426172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY121183800Medicaid
KS200376720AMedicaid
UT1851376347Medicaid
AZ929010Medicaid
CO20922850Medicaid
NE84-059792913Medicaid
NEP00720342OtherRR MCR NE
SD1851376347Medicaid
NM28102517Medicaid
OH0062769Medicaid
NE10025709000Medicaid
COP00312918OtherRR RIA MEDICARE
CO026810OtherKAISER COMMERCIAL NUMBER
COP00385462OtherRR MIC MEDICARE
CO391878ZLJ3Medicare PIN
KSP01400370Medicare PIN
NENA1215001Medicare PIN
SD1851376347Medicaid
WY121183800Medicaid
NM28102517Medicaid
NEKA2517006Medicare PIN
KS200376720AMedicaid
CO391878YK5YMedicare PIN
COC804997Medicare PIN
NENA1214001Medicare PIN
COP00312918OtherRR RIA MEDICARE
KS111257043Medicare PIN