Provider Demographics
NPI:1881653111
Name:HOMPLAND, SCOTT J (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:HOMPLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3333 S BANNOCK ST
Mailing Address - Street 2:#605
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2432
Mailing Address - Country:US
Mailing Address - Phone:303-788-9332
Mailing Address - Fax:303-788-9335
Practice Address - Street 1:3333 S BANNOCK ST
Practice Address - Street 2:#605
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2432
Practice Address - Country:US
Practice Address - Phone:303-788-9332
Practice Address - Fax:303-788-9335
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28824207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01288240Medicaid
CO01288240Medicaid
COJ1318Medicare PIN