Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 5404 | CO |
NPI | 1760505333 |
---|---|
Provider Name | Dr. Robert Shane Steadman |
First Address | Englewood, CO 80110-3421 |
Second Address | Englewood, CO 80110-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 28/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V07700 | (02) | CO |