Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | ME81339 | FL |
Y | 207QA0505X | Family Doctor - Adult Medicine | ME81339 | FL |
NPI | 1124087317 |
---|---|
Provider Name | Dr. Karen Wang Shannon |
First Address | Gainesville, FL 32607-4962 |
Second Address | Gainesville, FL 32605-6414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 19/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053127800 | (05) | FL |
E75962 | (02) | FL |
H28447 | (02) | FL |