Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 43539 | CO |
NPI | 1013999895 |
---|---|
Provider Name | Ravi C Shah |
First Address | Parker, CO 80138-8880 |
Second Address | Parker, CO 80138-8880 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 06/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I42906 | (02) | CO |