Individual
STEPHAN W SHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
859 S 4TH AVE, BRIGHTON, CO 80601-3543
(303) 338-4545
Mailing address
859 S 4TH AVE, BRIGHTON, CO 80601-3543
(303) 338-4545
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-098583
IL
207R00000X
Internal Medicine Physician
Primary
47019
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019392
KAISER COMMERCIAL NUMBER
CO
05
—
036009853
—
IL
05
—
26588021
—
CO
Enumeration date
10/19/2006
Last updated
09/09/2011
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