Healthcare Provider Details

I. General information

NPI: 1831194950
Provider Name (Legal Business Name): SHAUN PATRICK THOMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 FREMONT AVE
FORT MORGAN CO
80701-3553
US

IV. Provider business mailing address

PO BOX 2153 DEPT 40339
BIRMINGHAM AL
35287-9387
US

V. Phone/Fax

Practice location:
  • Phone: 970-867-8261
  • Fax: 970-867-1931
Mailing address:
  • Phone: 706-271-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36467
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: