Provider Demographics
NPI:1962708933
Name:SCOTT A. BRANDT, MD PC
Entity type:Organization
Organization Name:SCOTT A. BRANDT, MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-689-2380
Mailing Address - Street 1:7447 E BERRY AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11160 HURON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4377
Practice Address - Country:US
Practice Address - Phone:303-689-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36941208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF68027Medicare UPIN
COC806955Medicare PIN