Provider Demographics
NPI:1437138369
Name:JUENEMANN, SHANE AUGUST (MD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:AUGUST
Last Name:JUENEMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-7599
Mailing Address - Fax:303-530-5474
Practice Address - Street 1:6685 GUNPARK DR STE 110
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3343
Practice Address - Country:US
Practice Address - Phone:303-530-3062
Practice Address - Fax:303-530-5474
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2017-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO42518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58634266Medicaid
COCOA102939Medicare PIN
CO58634266Medicaid