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General NPI Number Information
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NPI Number | 1497804520
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Entity Type | Individual
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Provider Name | RICHARD A SHAND MD
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 111 W 2ND ST
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City | LA JUNTA
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State | CO
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Zip | 81050-1508
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Country | US
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Telephone | 719-384-2771
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Fax | 719-384-2077
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Provider Business Mailing Address
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Address Line | 111 W 2ND ST P.O. BOX 496
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City | LA JUNTA
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State | CO
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Zip | 81050-1508
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Country | US
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Telephone | 719-384-2771
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Fax | 719-384-2077
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20661
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License Number State | CO
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Legacy Identifiers
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Identifier #1
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Identifier Code | 01206614
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Identifier Type | MEDICAID
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Identifier State | CO
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 01206614
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Identifier Type | MEDICAID
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Identifier State | CO
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Identifier Issuer |
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