Healthcare Provider Details

I. General information

NPI: 1144200692
Provider Name (Legal Business Name): SCOTT A COLQUHOUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 E TUOLUMNE RD STE 107
TURLOCK CA
95382-1546
US

IV. Provider business mailing address

220 STANDIFORD AVE STE F
MODESTO CA
95350-1159
US

V. Phone/Fax

Practice location:
  • Phone: 209-579-5628
  • Fax:
Mailing address:
  • Phone: 209-579-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA91500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: