Provider Demographics
NPI:1831194950
Name:THOMPSON, SHAUN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:PATRICK
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2153 DEPT 40339
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-9387
Mailing Address - Country:US
Mailing Address - Phone:706-271-0100
Mailing Address - Fax:
Practice Address - Street 1:815 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3553
Practice Address - Country:US
Practice Address - Phone:970-867-8261
Practice Address - Fax:970-867-1931
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01364678Medicaid
CO01364678Medicaid
COC437978Medicare PIN
CO437978Medicare ID - Type UnspecifiedINDIVIDUAL
COG30918Medicare UPIN