Healthcare Provider Details

I. General information

NPI: 1669785937
Provider Name (Legal Business Name): ANDREW PHILLIP SCHANNEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LOUISIANA BLVD NE STE 410
ALBUQUERQUE NM
87110-5412
US

IV. Provider business mailing address

1248 N NORTON AVE
TUCSON AZ
85719-4715
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-4300
  • Fax: 505-338-0034
Mailing address:
  • Phone: 802-310-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD2016-0639
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: