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General NPI Number Information
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NPI Number | 1295362820
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Entity Type | Individual
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Provider Name | MATTHEW CLAIBOURNE SHONNARD MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 3551 E OVERLAND RD
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City | MERIDIAN
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State | ID
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Zip | 83642-6757
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Country | US
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Telephone | 775-327-5174
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1128
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City | BOISE
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State | ID
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Zip | 83701-1128
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Country | US
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Telephone | 208-884-1333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 9971149
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License Number State | ID
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