Provider Demographics
NPI:1003075151
Name:SHAMIS, MASON SIDNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:SIDNEY
Last Name:SHAMIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3702 AUTOMATION WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5737
Mailing Address - Country:US
Mailing Address - Phone:970-224-1670
Mailing Address - Fax:970-495-6218
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:SUITE 370
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3400
Practice Address - Country:US
Practice Address - Phone:970-221-2290
Practice Address - Fax:970-221-2293
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2014-11-03
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Provider Licenses
StateLicense IDTaxonomies
CO47000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18050867Medicaid
COCOAAA1097OtherMEDICARE ID