Basic Information
| Provider Information | |||||||||
| NPI: | 1891756839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEEHAN | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 SHERMAN ST | ||||||||
| Address2: | STE 510 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802034400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037448644 | ||||||||
| FaxNumber: | 3037800787 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 SHERMAN ST | ||||||||
| Address2: | STE 510 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802034400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037448644 | ||||||||
| FaxNumber: | 3037800787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 04/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP3000X | 38424 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 115124000 | 05 | WY | MEDICAID | 1891756839 | 05 | MT | MEDICAID | 74230875 | 05 | CO | MEDICAID |