Provider Demographics
NPI:1205929841
Name:HALLGREN, SCOTT EDWIN (DO, FACP)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWIN
Last Name:HALLGREN
Suffix:
Gender:M
Credentials:DO, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HEALTH PARK DR STE 270
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4644
Mailing Address - Country:US
Mailing Address - Phone:303-269-2085
Mailing Address - Fax:303-269-2089
Practice Address - Street 1:80 HEALTH PARK DR STE 270
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-4644
Practice Address - Country:US
Practice Address - Phone:303-269-2085
Practice Address - Fax:303-269-2089
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5831207RG0100X
CODR.0028739207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80329OtherBCBS
FL063240600Medicaid
FL063240600Medicaid
FL80329BMedicare PIN
FLE59554Medicare UPIN