Provider Demographics
NPI:1700176534
Name:SHABASON, JACOB EZRA (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:EZRA
Last Name:SHABASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7951 E MAPLEWOOD AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4758
Mailing Address - Country:US
Mailing Address - Phone:303-930-7895
Mailing Address - Fax:832-601-6018
Practice Address - Street 1:10103 RIDGEGATE PKWY STE G01
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5521
Practice Address - Country:US
Practice Address - Phone:720-225-4200
Practice Address - Fax:720-225-4208
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.00701012085R0001X
PAMT198841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology