Provider Demographics
NPI:1619272648
Name:DOUGLAS C. SHENK, M.D.,. P.C.
Entity Type:Organization
Organization Name:DOUGLAS C. SHENK, M.D.,. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SHENK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-241-8097
Mailing Address - Street 1:308 BOOKCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2022
Mailing Address - Country:US
Mailing Address - Phone:970-241-8097
Mailing Address - Fax:
Practice Address - Street 1:308 BOOKCLIFF CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2022
Practice Address - Country:US
Practice Address - Phone:970-241-8097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01221639Medicaid
COD24041Medicare UPIN