Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 45755 | CO |
N | 207Q00000X | Family Doctor | T2004016530 | MO |
N | 207QS0010X | Family Doctor - Sports Medicine | 000 | NM |
Y | 207QS0010X | Family Doctor - Sports Medicine | DR.0045755 | CO |
NPI | 1285737395 |
---|---|
Provider Name | Dr. Shane Paul Cass |
First Address | Denver, CO 80247-1314 |
Second Address | Lafayette, CO 80026-3370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 12/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18506 | KAISER COMMERCIAL NUMBER (01) | CO |
25536338 | (05) | CO |