Provider Demographics
NPI:1851509137
Name:STRADER, SCOTT B (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:B
Last Name:STRADER
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 1:2315 E HARMONY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8620
Mailing Address - Country:US
Mailing Address - Phone:970-482-4373
Mailing Address - Fax:970-484-5682
Practice Address - Street 1:2315 E HARMONY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8620
Practice Address - Country:US
Practice Address - Phone:970-482-4373
Practice Address - Fax:970-484-5682
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00500742084N0400X
IAR-77962084N0400X
CO500742084N0600X
WY10813A2084N0400X
WYTL36082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11952750Medicaid
WY13322440Medicaid
COCOAAA1420Medicare PIN
WYW28407Medicare PIN