Provider Demographics
NPI:1255624755
Name:NOORDA, SCOTT (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:NOORDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E 700 S STE 201
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5732
Mailing Address - Country:US
Mailing Address - Phone:435-627-3500
Mailing Address - Fax:435-359-4508
Practice Address - Street 1:640 E 700 S STE 201
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5732
Practice Address - Country:US
Practice Address - Phone:435-627-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9705544-1204207Q00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCK106AMedicare PIN
NCP01406061Medicare PIN