MEDICARE: SHANNON EDMONDS ARDOIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	E-4819	AR
2	2085R0202X	Diagnostic Radiology Physician	MD.026096	LA

General Provider Information

NPI Number	:	1053575506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON EDMONDS ARDOIN MD

Provider Business Mailing Address
First Line	:	44 COLONY RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-2947
Country	:	US
Telephone Number	:	501-960-2422
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 COLONY RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-2947
Country	:	US
Telephone Number	:	501-960-2422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	06/09/2016

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