MEDICARE: SHAWN B ALLEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	43816	CO
2	207ND0900X	Dermatopathology Physician	43816	CO
3	207NS0135X	Procedural Dermatology Physician	43816	CO
4	207ND0101X	MOHS-Micrographic Surgery Physician	43816	CO

General Provider Information

NPI Number	:	1043340805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN B ALLEN MD

Provider Business Mailing Address
First Line	:	1056 S 88TH ST
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-9460
Country	:	US
Telephone Number	:	303-442-6647
Fax Number	:	303-442-2696

Provider Business Practice Location Address
First Line	:	2880 FOLSOM ST STE 200
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3769
Country	:	US
Telephone Number	:	303-442-6647
Fax Number	:	303-442-2696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	06/02/2022

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