Basic Information
| Provider Information | |||||||||
| NPI: | 1528013000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIRAR | ||||||||
| FirstName: | LORA | ||||||||
| MiddleName: | ELANE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHIRAR | ||||||||
| OtherFirstName: | L | ||||||||
| OtherMiddleName: | ELANE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5920 MCINTYRE ST | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804037445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039491250 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5920 MCINTYRE ST | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804037445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039491250 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 05/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 10013 | MT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 108606 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 33226 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01332261 | 05 | CO | MEDICAID | C080183782 | 01 | CO | RAILROAD MEDICARE | OTHER | C304127 | 05 | CO | MEDICAID | C373888 | 05 | CO | MEDICAID | C524308 | 05 | CO | MEDICAID | P00012544 | 01 | CO | RAILROAD MEDICARE | OTHER | 806323000 | 05 | ID | MEDICAID | P00071247 | 01 | CO | RAILROAD MEDICARE | OTHER | C396338 | 05 | CO | MEDICAID | C488148 | 05 | CO | MEDICAID | C080182858 | 01 | CO | RAILROAD MEDICARE | OTHER |