Provider Demographics
NPI:1497804520
Name:SHAND, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:SHAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W 2ND ST
Mailing Address - Street 2:P.O. BOX 496
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1508
Mailing Address - Country:US
Mailing Address - Phone:719-384-2771
Mailing Address - Fax:719-384-2077
Practice Address - Street 1:111 W 2ND ST
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1508
Practice Address - Country:US
Practice Address - Phone:719-384-2771
Practice Address - Fax:719-384-2077
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01206614Medicaid
COD23816Medicare UPIN
COCL3708Medicare PIN