Provider Demographics
NPI:1841290079
Name:SCOTT, WILLIAM A (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:A
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1120 WELLINGTON AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6129
Mailing Address - Country:US
Mailing Address - Phone:970-241-0170
Mailing Address - Fax:970-241-2035
Practice Address - Street 1:1120 WELLINGTON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6129
Practice Address - Country:US
Practice Address - Phone:970-241-0170
Practice Address - Fax:970-241-2035
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01176114Medicaid
COC265518Medicare PIN
COD23311Medicare UPIN
CO01176114Medicaid