Provider Demographics
NPI:1285603043
Name:BRANDT, SCOTT A (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:BRANDT
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 1:280 MAIN ST
Mailing Address - Street 2:UNIT C-104
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632
Mailing Address - Country:US
Mailing Address - Phone:970-766-8245
Mailing Address - Fax:970-432-7065
Practice Address - Street 1:280 MAIN ST
Practice Address - Street 2:UNIT C-104
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-766-8245
Practice Address - Fax:970-432-7065
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36941207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO604688OtherBLUE CROSS BLUE SHIELD
CO604688OtherBLUE CROSS BLUE SHIELD
COC802450Medicare ID - Type Unspecified