Individual
SHANNON SMITH SOVNDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1100 BALSAM AVE, BOULDER, CO 80304-3404
(303) 440-2037
Mailing address
P.O. BOX 173894, DENVER, CO 80304-3404
(303) 306-7783
(303) 306-7753
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
41265
CO
207P00000X
Emergency Medicine Physician
Primary
DR.0041265
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86032330
—
CO
01
—
P00019485
RAILROAD MEDICARE
CO
Enumeration date
12/28/2005
Last updated
02/14/2025
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