Provider Demographics
NPI:1881663763
Name:SELCO, SCOTT LOREN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LOREN
Last Name:SELCO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 S EASTERN AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3908
Mailing Address - Country:US
Mailing Address - Phone:702-616-5617
Mailing Address - Fax:602-798-9949
Practice Address - Street 1:10001 S EASTERN AVE STE 410
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3908
Practice Address - Country:US
Practice Address - Phone:702-616-5617
Practice Address - Fax:602-798-9949
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV111892084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1881663763Medicaid
NV100504507Medicaid
UT1881663763Medicaid
AZ971508Medicaid
CAXPY205008Medicaid
NV1881663763Medicaid
AZ1881663763Medicaid
NV1881663763Medicaid
H85326Medicare UPIN
H85326Medicare UPIN