Provider Demographics
NPI:1831141290
Name:SHANK, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:SHANK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2446 RESEARCH PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1087
Mailing Address - Country:US
Mailing Address - Phone:719-623-1050
Mailing Address - Fax:719-623-1052
Practice Address - Street 1:2446 RESEARCH PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1087
Practice Address - Country:US
Practice Address - Phone:719-623-1050
Practice Address - Fax:719-623-1052
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COCO40999207X00000X, 207XX0004X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85089320Medicaid
CO85089320Medicaid
CO805467Medicare PIN