Provider Demographics
NPI:1548247174
Name:SCOW, DEAN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:THOMAS
Last Name:SCOW
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 1:3150 N 12TH ST
Mailing Address - Street 2:P.O. BOX 10700
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-2863
Mailing Address - Country:US
Mailing Address - Phone:970-255-1576
Mailing Address - Fax:970-254-2398
Practice Address - Street 1:3150 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-2863
Practice Address - Country:US
Practice Address - Phone:970-255-1576
Practice Address - Fax:970-254-2398
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45708550Medicaid
CO45708550Medicaid
COCOAAA1231Medicare PIN