Healthcare Provider Details

I. General information

NPI: 1063702538
Provider Name (Legal Business Name): SCOTT M CASTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BLAKE AVE
GLENWOOD SPRINGS CO
81601-4227
US

IV. Provider business mailing address

PO BOX 2270
GLENWOOD SPRINGS CO
81602-2270
US

V. Phone/Fax

Practice location:
  • Phone: 970-928-0808
  • Fax: 970-928-7591
Mailing address:
  • Phone: 970-384-7033
  • Fax: 970-945-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number82404
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number53909
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberDR.0069938
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: