Provider Demographics
NPI:1275850158
Name:DORN, SCOTT HAROLD (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:HAROLD
Last Name:DORN
Suffix:
Gender:M
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2277
Mailing Address - Country:US
Mailing Address - Phone:303-979-7200
Mailing Address - Fax:303-933-5265
Practice Address - Street 1:7335 S PIERCE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4571
Practice Address - Country:US
Practice Address - Phone:303-979-7200
Practice Address - Fax:303-933-5265
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0004439363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical