Provider Demographics
NPI:1447302591
Name:CAMPBELL, SCOT ELLIOT (MD)
Entity type:Individual
Prefix:
First Name:SCOT
Middle Name:ELLIOT
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM91902085R0202X
UT10684133-12052085R0202X
OK232272085R0202X
HIMD204722085R0202X
KS04-420272085R0202X
NE315722085R0202X
CO617452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO786784OtherMEDICARE
CO786787OtherMEDICARE
CO786786OtherMEDICARE
NENA2517117OtherMEDICARE
KS111257126OtherMEDICARE
CO786790OtherMEDICARE
NENA1214140OtherMEDICARE
KSKA3249117OtherMEDICARE
NENA1215141OtherMEDICARE
CO786785OtherMEDICARE
CO786789OtherMEDICARE
CO9000170776Medicaid