Provider Demographics
NPI:1255360889
Name:KINKADE, ROBERT SCOTT (M D)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:KINKADE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 W. MINGUS AVE, STE 1D
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326
Mailing Address - Country:US
Mailing Address - Phone:928-649-1000
Mailing Address - Fax:928-649-3929
Practice Address - Street 1:651 W MINGUS AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4006
Practice Address - Country:US
Practice Address - Phone:928-649-1000
Practice Address - Fax:928-649-3929
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26410208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ442153Medicaid
AZAZ0863930OtherBCBS ID NUMBER
AZ020046038OtherRAILROAD MEDICARE ID NUMB
AZ020046038OtherRAILROAD MEDICARE ID NUMB
AZ442153Medicaid
AZAZ0863930OtherBCBS ID NUMBER