Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | CO40999 | CO |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | CO40999 | CO |
N | 207XX0801X | Orthopaedic Trauma Surgeon | CO40999 | CO |
NPI | 1831141290 |
---|---|
Provider Name | Dr. John R Shank |
First Address | Colorado Springs, CO 80920-1087 |
Second Address | Colorado Springs, CO 80920-1087 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 18/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
85089320 | (05) | CO |
H85842 | (02) | CO |