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NPI Code Detail

MEDICARE: AMIE B SHANNON M.D.

MEDICARE: AMIE B SHANNON M.D.
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
1207N00000XDermatology Physician200217LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386631935
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMIE B SHANNON M.D.
Provider Business Mailing Address
First Line : 5326 O'DONOVAN DRIVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-9153
Country : US
Telephone Number : 225-769-7546
Fax Number : 225-769-0471
Provider Business Practice Location Address
First Line : 5326 O'DONOVAN DRIVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-9153
Country : US
Telephone Number : 225-769-7546
Fax Number : 225-769-0471
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 01/20/2009

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