Healthcare Provider Details

I. General information

NPI: 1346395985
Provider Name (Legal Business Name): SCOTT E VINCENT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CENTER AVE
GRAND JUNCTION CO
81501-2041
US

IV. Provider business mailing address

601 CENTER AVE
GRAND JUNCTION CO
81501-2041
US

V. Phone/Fax

Practice location:
  • Phone: 970-263-7348
  • Fax: 970-241-1674
Mailing address:
  • Phone: 970-263-7348
  • Fax: 970-241-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33850
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number33850
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number33850
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: