Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 27321 | WI |
NPI | 1043282221 |
---|---|
Provider Name | Dr. William P Shannon |
First Address | Middleton, WI 53562-5531 |
Second Address | Middleton, WI 53562-3036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 26/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30852700 | (05) | WI |
B56536 | (02) |