Healthcare Provider Details

I. General information

NPI: 1003554676
Provider Name (Legal Business Name): SHANNON E COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W HOSPITAL DR STE 255
TUCSON AZ
85704-7857
US

IV. Provider business mailing address

4801 E BROADWAY BLVD STE 251
TUCSON AZ
85711-2700
US

V. Phone/Fax

Practice location:
  • Phone: 205-547-5725
  • Fax: 520-547-5735
Mailing address:
  • Phone: 520-327-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number76353
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number35300
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number76353
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: