Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 15356 | CO |
NPI | 1336461227 |
---|---|
Provider Name | Ronald D Shippert |
First Address | Cherry Hills Village, CO 80121-2003 |
Second Address | Centennial, CO 80111-6484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2010 |
Last Update Date | 19/02/2010 |