Provider Demographics
NPI:1578545570
Name:OTTEMAN, SHAWN B (DO)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:B
Last Name:OTTEMAN
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Gender:M
Credentials:DO
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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:303-415-4355
Mailing Address - Fax:303-666-1982
Practice Address - Street 1:1000 W S BOULDER RD
Practice Address - Street 2:STE 110
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2752
Practice Address - Country:US
Practice Address - Phone:303-415-4355
Practice Address - Fax:303-666-1982
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
CO34137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01341379Medicaid
COC495338Medicare PIN
COF99815Medicare UPIN
COP00006717Medicare PIN