Healthcare Provider Details

I. General information

NPI: 1003075151
Provider Name (Legal Business Name): MASON SIDNEY SHAMIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E HARMONY RD SUITE 370
FORT COLLINS CO
80528-3400
US

IV. Provider business mailing address

3702 AUTOMATION WAY SUITE 103
FORT COLLINS CO
80525-5737
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-2290
  • Fax: 970-221-2293
Mailing address:
  • Phone: 970-224-1670
  • Fax: 970-495-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47000
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: