Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 2000-105 | NM |
NPI | 1629387261 |
---|---|
Provider Name | William Michael Shannon |
First Address | Albuquerque, NM 87151-0100 |
Second Address | Albuquerque, NM 87151-0100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2010 |
Last Update Date | 30/09/2010 |