Individual
DR. BENJAMIN LOREN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1750 E KEN PRATT BLVD, LONGMONT, CO 80504-5311
(720) 718-7000
(870) 207-6581
Mailing address
2695 ROCKY MOUNTAIN AVENUE, SUITE 150, LOVELAND, CO 80538
(970) 624-4440
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
58.001782
OH
207R00000X
Internal Medicine Physician
Primary
DR0058636
CO
207R00000X
Internal Medicine Physician
E5527
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173381003
—
AR
05
—
1952424657
—
MO
01
—
58.001782
OHIO LICENSE TRAINING CER
OH
01
—
P00924052
RAILROAD MEDICARE
AR
Enumeration date
04/09/2007
Last updated
05/22/2017
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