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NPI Code Detail

MEDICARE: DR. LARRY EUGENE SHORES M.D.

MEDICARE: DR. LARRY EUGENE SHORES M.D.
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
12084P0800XPsychiatry Physician34757CO
22084P0804XChild & Adolescent Psychiatry Physician34757CO

General Provider Information

NPI Number : 1518093715
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY EUGENE SHORES M.D.
Provider Business Mailing Address
First Line : 2135 SOUTHGATE RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-2605
Country : US
Telephone Number : 719-633-4114
Fax Number :
Provider Business Practice Location Address
First Line : 2135 SOUTHGATE RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-2605
Country : US
Telephone Number : 719-633-4114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2007
Last Update Date : 03/03/2009

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