Provider Demographics
NPI:1285712703
Name:FOUNTAIN, SHEILA MARIE (MD)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 CENTRAL PARK DRIVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8816
Mailing Address - Country:US
Mailing Address - Phone:970-871-1900
Mailing Address - Fax:970-870-3138
Practice Address - Street 1:940 CENTRAL PARK DRIVE
Practice Address - Street 2:SUITE #201
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8816
Practice Address - Country:US
Practice Address - Phone:970-871-1900
Practice Address - Fax:970-870-3138
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41312208000000X
COCO41312208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02002248Medicaid