Provider Demographics
NPI:1942289491
Name:DHUPAR, SCOTT K (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
Last Name:DHUPAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 W 9TH ST
Mailing Address - Street 2:UNIT #1B
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4462
Mailing Address - Country:US
Mailing Address - Phone:970-353-5959
Mailing Address - Fax:970-353-5967
Practice Address - Street 1:6200 W 9TH ST
Practice Address - Street 2:UNIT #1B
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4462
Practice Address - Country:US
Practice Address - Phone:970-353-5959
Practice Address - Fax:970-353-5967
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO43465207X00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2080851Medicaid
MA2080851Medicaid
COC809294Medicare PIN