Healthcare Provider Details

I. General information

NPI: 1619790961
Provider Name (Legal Business Name): SHANNON M LINTON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-9707
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-3521
  • Fax: 209-754-2675
Mailing address:
  • Phone: 877-747-5050
  • Fax: 775-747-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHANNON M LINTON
Title or Position: OWNER
Credential: MD
Phone: 209-754-2523