Provider Demographics
NPI:1639171440
Name:SHIFFMAN, MARC S (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:S
Last Name:SHIFFMAN
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:PO BOX 4009
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-4009
Mailing Address - Country:US
Mailing Address - Phone:970-668-3911
Mailing Address - Fax:970-668-5650
Practice Address - Street 1:730 SUMMIT BLVD
Practice Address - Street 2:101
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-3911
Practice Address - Fax:970-668-5650
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73431273Medicaid
COC807945Medicare PIN
COD16145Medicare UPIN