Provider Demographics
NPI:1053607564
Name:WALMER, SCOTT ANDREW (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANDREW
Last Name:WALMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:56 CLUB MANOR DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1685
Practice Address - Country:US
Practice Address - Phone:719-584-4767
Practice Address - Fax:719-595-7906
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0523482084P0800X
CODR.00571212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry