Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 42959 | TN |
N | 111NI0900X | Internist | 42959 | TN |
N | 207R00000X | Internist | 49143 | CO |
N | 111NI0900X | Internist | 49143 | CO |
Y | 207RR0500X | Rheumatology | 49143 | CO |
NPI | 1063600336 |
---|---|
Provider Name | Shiraz Moinuddin |
First Address | Longmont, CO 80501-9617 |
Second Address | Broomfield, CO 80020-1870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2007 |
Last Update Date | 19/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05623537 | (05) | CO |