Provider Demographics
NPI:1538149794
Name:SEGAL, SCOTT DAVID (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:SEGAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2403
Mailing Address - Fax:970-490-4173
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-365-1292
Practice Address - Fax:719-365-6997
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2018-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00002054207Q00000X
CODR.0052634207Q00000X
ORDO23435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR244091Medicaid
OR138926OtherMEDICARE PTAN