| NPI | 1073896700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT SHANNON Owner/Member 970-221-1106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO 31090) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 31090) |
| 207R00000X Internal Medicine (Licence: CO 31090) | |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2011-09-20 |