Provider Demographics
NPI:1124113121
Name:RUDDEROW, SHIREEN J (MD)
Entity type:Individual
Prefix:DR
First Name:SHIREEN
Middle Name:J
Last Name:RUDDEROW
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:719-278-3672
Mailing Address - Fax:719-623-2101
Practice Address - Street 1:1633 MEDICAL CENTER POINT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-636-2999
Practice Address - Fax:719-667-4108
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0050089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51705729Medicaid
CO51705729Medicaid
COCOAAA2773Medicare PIN