Healthcare Provider Details

I. General information

NPI: 1740594233
Provider Name (Legal Business Name): SCOTT LLOYD WHITWORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FT CARSON CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR
FORT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-4044
  • Fax:
Mailing address:
  • Phone: 719-524-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number24690
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: