1538587092 NPI number — SHANNON MOSELEY FLOOD MD

Table of content: SHANNON MOSELEY FLOOD MD (NPI 1538587092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538587092 NPI number — SHANNON MOSELEY FLOOD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLOOD
Provider First Name:
SHANNON
Provider Middle Name:
MOSELEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOSELEY
Provider Other First Name:
SHANNON
Provider Other Middle Name:
ELEANOR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538587092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13001 E. 17TH PLACE
Provider Second Line Business Mailing Address:
UNIVERSITY OF COLORADO SCHOOL OF MEDICINE GME
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80045-2581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-777-3846
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13123 E 16TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80045-7106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-777-1234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: DR0058567 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)