Provider Demographics
NPI:1013933274
Name:SCANLAN, MARK RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:SCANLAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 W 42ND ST
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4669
Mailing Address - Country:US
Mailing Address - Phone:308-635-3888
Mailing Address - Fax:308-630-1817
Practice Address - Street 1:2 W 42ND ST
Practice Address - Street 2:SUITE 3200
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4669
Practice Address - Country:US
Practice Address - Phone:308-635-3888
Practice Address - Fax:308-630-1817
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE202032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE260029617OtherRR MEDICARE
NE260029617OtherRR MEDICARE
267799Medicare PIN