Individual
RANDALL J SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 S CLARK ST, BUTTE, MT 59701-2328
(406) 782-7442
Mailing address
PO BOX 4108, BUTTE, MT 59702-4108
(406) 782-7442
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
8104
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011991
BCBS
MT
05
—
019994
—
MT
Enumeration date
08/23/2006
Last updated
01/14/2008
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