Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 35-05-2695-5 | OH |
NPI | 1043210727 |
---|---|
Provider Name | Michael B Shannon |
First Address | Zanesville, OH 43701-1741 |
Second Address | Zanesville, OH 43701-2861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 07/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0619156 | (05) | OH |
31116457500 | BWC (01) | OH |
A16363 | (02) |