Provider Demographics
NPI:1972506160
Name:SCALA, JOHN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:SCALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4707
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80155-4707
Mailing Address - Country:US
Mailing Address - Phone:720-463-0010
Mailing Address - Fax:303-593-2120
Practice Address - Street 1:13111 E BRIARWOOD AVE STE 210
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3846
Practice Address - Country:US
Practice Address - Phone:720-463-0010
Practice Address - Fax:303-593-2120
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48613207R00000X
IL036096720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75734044Medicaid
IL036096720Medicaid
G96441Medicare UPIN
ILK11820Medicare PIN
COCOAAA0396Medicare PIN
COP00996397Medicare PIN