MEDICARE: DR. SCOTT BLITZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	33657	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477557825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT BLITZ M.D.

Provider Business Mailing Address
First Line	:	1707 COLE BLVD
Second Line	:	STE 100
City	:	GOLDEN
State	:	CO
Zip	:	80401-3220
Country	:	US
Telephone Number	:	303-716-8013
Fax Number	:	303-763-5495

Provider Business Practice Location Address
First Line	:	7550 W YALE AVE
Second Line	:	BLDG B - #100
City	:	DENVER
State	:	CO
Zip	:	80227-3465
Country	:	US
Telephone Number	:	303-935-4689
Fax Number	:	303-935-3829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/04/2013

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