Individual
SHAWN JETT NAKAMURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4112 OUTLOOK BLVD STE 37, PUEBLO, CO 81008-1667
(719) 562-6254
(719) 562-6255
Mailing address
230 BRIDLE TRL, PUEBLO, CO 81005-2906
(719) 252-1064
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
44158
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28624777
—
CO
01
—
P00031174
MEDICARE RAILROAD
MN
Enumeration date
12/12/2005
Last updated
07/21/2022
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