Provider Demographics
NPI:1700995644
Name:COLTHARP, SCOTT ALLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALLEN
Last Name:COLTHARP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 JOE WIMBERLEY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5997
Mailing Address - Country:US
Mailing Address - Phone:512-847-7700
Mailing Address - Fax:512-847-7701
Practice Address - Street 1:180 JOE WIMBERLEY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5997
Practice Address - Country:US
Practice Address - Phone:512-847-7700
Practice Address - Fax:512-847-7701
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant