Individual
TIMOTHY RICHARD SHANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12650 W 64TH AVE UNIT E501, ARVADA, CO 80004-3893
(303) 431-4127
Mailing address
827 S VANCE ST APT A-305, LAKEWOOD, CO 80226-5614
(610) 331-8346
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0005534
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005534
COLORADO PA LICENSE
CO
01
—
1155401
NCCPA
—
Enumeration date
09/30/2018
Last updated
09/30/2018
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