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General NPI Number Information
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NPI Number | 1477057883
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Entity Type | Individual
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Provider Name | SHANNON ALTAZAN DO
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Gender | Male
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 401 MATTHEW ST
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City | MARIETTA
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State | OH
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Zip | 45750-1635
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Country | US
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Telephone | 740-376-1939
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Fax | 740-374-1693
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Provider Business Mailing Address
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Address Line | 1467 TORNES RD
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City | LOWELL
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State | OH
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Zip | 45744-7187
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Country | US
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Telephone | 225-802-2197
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34.015793
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34.015793
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 3742
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License Number State | WV
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