Provider Demographics
NPI:1639143753
Name:SHAW, ROSEANNE D (MD)
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:D
Last Name:SHAW
Suffix:
Gender:F
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:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498-1225
Mailing Address - Country:US
Mailing Address - Phone:970-668-0895
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 9 AND SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-3300
Practice Address - Fax:978-668-8123
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21960207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01219609Medicaid
COH36439Medicare UPIN
CO803474Medicare ID - Type Unspecified