Provider Demographics
NPI:1508455726
Name:SHAMBUREK, DANIEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:SHAMBUREK
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 1:790 S RACE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4607
Mailing Address - Country:US
Mailing Address - Phone:720-448-3423
Mailing Address - Fax:
Practice Address - Street 1:790 S RACE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4607
Practice Address - Country:US
Practice Address - Phone:720-448-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine