Individual
JACOB SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
500 UNIVERSITY DR, HERSHEY, PA 17033-2360
(717) 531-8333
Mailing address
500 UNIVERSITY DR, HERSHEY, PA 17033-2360
(717) 531-8333
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OT012580
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053579292
—
PA
Enumeration date
05/23/2008
Last updated
06/02/2011
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