MEDICARE: JOHN A SCOTT JR. EDD

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	103TC0700X	Clinical Psychologist	2704	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	:	1679663462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A SCOTT JR. EDD

Provider Business Mailing Address
First Line	:	6481 REDWING PL
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80503-8720
Country	:	US
Telephone Number	:	720-341-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	11059 E BETHANY DR
Second Line	:	SUITE 200
City	:	AURORA
State	:	CO
Zip	:	80014-2622
Country	:	US
Telephone Number	:	303-617-2332
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	04/03/2017

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