Basic Information
| Provider Information | |||||||||
| NPI: | 1659371920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | BRENT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13650E MISSIPPI AVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800123573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036958684 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13650 E MISSISSIPPI AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800123573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036958684 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3219 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DR.0044016 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.