Provider Demographics
NPI:1942262209
Name:FAULKNER, SCOTT E (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:FAULKNER
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 1:2350 MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8405
Mailing Address - Country:US
Mailing Address - Phone:719-776-8040
Mailing Address - Fax:
Practice Address - Street 1:2350 MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8405
Practice Address - Country:US
Practice Address - Phone:719-776-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0039644207R00000X, 208M00000X
CO39644174400000X
AZ67330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82506779Medicaid
CO110235029OtherRAILROAD MEDICARE
COC488708Medicare PIN
CO110235029OtherRAILROAD MEDICARE
COCO306857Medicare PIN
COH43255Medicare UPIN