Healthcare Provider Details

I. General information

NPI: 1831166636
Provider Name (Legal Business Name): SHANE B ROWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E KEN PRATT BLVD STE 205
LONGMONT CO
80504-5311
US

IV. Provider business mailing address

1760 E KEN PRATT BLVD STE 205
LONGMONT CO
80504-5311
US

V. Phone/Fax

Practice location:
  • Phone: 720-718-8180
  • Fax:
Mailing address:
  • Phone: 720-718-8180
  • Fax: 720-718-5989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number095600
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberDR.0042860
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: