Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS13425 | FL |
Y | 207R00000X | Internist | DR.0055204 | CO |
Y | 111NI0900X | Internist | DR.0055204 | CO |
NPI | 1265823256 |
---|---|
Provider Name | Shawna L De Graff Roberson |
First Address | Arvada, CO 80004-4034 |
Second Address | Arvada, CO 80004-4034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2015 |
Last Update Date | 16/07/2015 |