MEDICARE: DR. SHANNON LYNN MARKEGARD DO

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	207Q00000X	Family Medicine Physician	OP00002047	WA

General Provider Information

NPI Number	:	1124067087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON LYNN MARKEGARD DO

Provider Business Mailing Address
First Line	:	3600 LIND AVE SW
Second Line	:	STE 100
City	:	RENTON
State	:	WA
Zip	:	98057-4934
Country	:	US
Telephone Number	:	425-656-5412
Fax Number	:	425-656-4079

Provider Business Practice Location Address
First Line	:	23846 SE KENT KANGLEY RD
Second Line	:
City	:	MAPLE VALLEY
State	:	WA
Zip	:	98038-6848
Country	:	US
Telephone Number	:	425-656-4100
Fax Number	:	425-656-4109

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	01/21/2008

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