Individual
DR. KRISTOPHER RYAN SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
850 YELLOWSTONE AVE, POCATELLO, ID 83201-4415
(208) 239-8065
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1799
(208) 785-3813
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
12009729-1205
UT
207P00000X
Emergency Medicine Physician
17765
NV
207P00000X
Emergency Medicine Physician
Primary
M-16351
ID
261QU0200X
Urgent Care Clinic/Center
M-16351
ID
Other
Enumeration date
04/06/2015
Last updated
10/17/2025
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