Healthcare Provider Details

I. General information

NPI: 1417488115
Provider Name (Legal Business Name): EVAN THOMPSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8565 POPLAR WAY
HIGHLANDS RANCH CO
80130-3602
US

IV. Provider business mailing address

8565 POPLAR WAY
HIGHLANDS RANCH CO
80130-3602
US

V. Phone/Fax

Practice location:
  • Phone: 702-348-2800
  • Fax: 720-348-2899
Mailing address:
  • Phone: 720-348-2800
  • Fax: 720-348-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0066133
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: