Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | MD60096471 | WA |
NPI | 1164531497 |
---|---|
Provider Name | Dr. Michael Caroll Shannon |
First Address | Seattle, WA 98104-1307 |
Second Address | Seattle, WA 98104-1307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 26/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8549958 | (05) | WA |
E16328 | (02) | |
L6647 | (05) | NM |