Healthcare Provider Details

I. General information

NPI: 1932135795
Provider Name (Legal Business Name): NEAL H SHONNARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 5TH ST SE SUITE 110
PUYALLUP WA
98374-2106
US

IV. Provider business mailing address

805 MADISON ST SUITE 901
SEATTLE WA
98104-1172
US

V. Phone/Fax

Practice location:
  • Phone: 253-845-9585
  • Fax: 253-435-4785
Mailing address:
  • Phone: 206-264-8100
  • Fax: 206-264-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD00027457
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: