Provider Demographics
NPI:1871810135
Name:RYNEARSON, SCOTT AUSTIN (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:AUSTIN
Last Name:RYNEARSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-475-3100
Mailing Address - Fax:801-475-3101
Practice Address - Street 1:5495 S 500 E
Practice Address - Street 2:STE 310
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6923
Practice Address - Country:US
Practice Address - Phone:801-475-3100
Practice Address - Fax:801-475-3101
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9024329-1204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000087403Medicare PIN