Healthcare Provider Details

I. General information

NPI: 1730507740
Provider Name (Legal Business Name): SHANNAN PATTERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 W RIVER RD STE 126
TUCSON AZ
85741-3080
US

IV. Provider business mailing address

3870 W RIVER RD STE 126
TUCSON AZ
85741-3080
US

V. Phone/Fax

Practice location:
  • Phone: 520-219-6616
  • Fax: 520-742-6187
Mailing address:
  • Phone: 520-219-6616
  • Fax: 520-742-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0065398
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1730507740
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: