Healthcare Provider Details

I. General information

NPI: 1275026643
Provider Name (Legal Business Name): SCOTT LUTHER REPLOGLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 W DILLON RD STE 1
LOUISVILLE CO
80027-1290
US

IV. Provider business mailing address

429 MAJESTIC VIEW DR
BOULDER CO
80303-4504
US

V. Phone/Fax

Practice location:
  • Phone: 720-485-5672
  • Fax:
Mailing address:
  • Phone: 303-666-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number22528
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: