Healthcare Provider Details

I. General information

NPI: 1649595802
Provider Name (Legal Business Name): SCOTT A. BRANDT, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7075 CAMPUS DR STE 102
COLORADO SPRINGS CO
80920-6524
US

IV. Provider business mailing address

7447 E BERRY AVE STE 150
GREENWOOD VILLAGE CO
80111-2142
US

V. Phone/Fax

Practice location:
  • Phone: 303-689-2300
  • Fax:
Mailing address:
  • Phone: 303-689-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number36941
License Number StateCO

VIII. Authorized Official

Name: CHRIS J DOOLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-689-2380