Provider Demographics
NPI:1063702538
Name:CASTLE, SCOTT M (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:CASTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2270
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-2270
Mailing Address - Country:US
Mailing Address - Phone:970-384-7033
Mailing Address - Fax:970-945-5460
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4227
Practice Address - Country:US
Practice Address - Phone:970-928-0808
Practice Address - Fax:970-928-7591
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82404208800000X
TN53909208800000X
CODR.0069938208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC824040Medicaid