Provider Demographics
NPI:1447264593
Name:HUMPHREYS, SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:HUMPHREYS
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 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-360-3260
Mailing Address - Fax:303-360-3388
Practice Address - Street 1:4900 S MONACO ST
Practice Address - Street 2:#210
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-3486
Practice Address - Country:US
Practice Address - Phone:303-360-3260
Practice Address - Fax:303-360-3388
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO426512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58438530Medicaid
NM71209832Medicaid
CO81258305Medicaid
COCO40523Medicare PIN
NM71209832Medicaid
I35002Medicare UPIN
COCOB4219Medicare PIN
COP00699207Medicare PIN
CO81258305Medicaid