# SHANNON SENIOR HEALTH CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194935569
- **Authorized official:** DR. IRVIN ZIETLER M.D. (PHYSICIAN)
- **Authorized official phone:** (325) 949-9408

## Contact information

- **Practice address:** 3016 VISTA DEL ARROYO DR, SAN ANGELO, TX 76904-6146
- **Practice address phone:** (325) 949-9408
- **Mailing address:** 3016 VISTA DEL ARROYO DR, SAN ANGELO, TX 76904-6146
- **Mailing address phone:** (325) 949-9408

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | F4722 | TX | Yes |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 08/22/2020