Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 300 | AK |
NPI | 1487743936 |
---|---|
Provider Name | Dr. John P Shannon JR. |
First Address | Anchorage, AK 99508-5205 |
Second Address | Anchorage, AK 99508-5205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T83177 | (02) | AK |