Individual
MR. MICHAEL JAMES SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATP
Contact information
Practice address
12406 STATE HIGHWAY 155 S, TYLER, TX 75703-6446
(903) 592-8931
(903) 592-8922
Mailing address
2407 WSW LOOP 323, TYLER, TX 75701
(903) 581-8844
(909) 581-9845
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
85900
TX
Other
Enumeration date
06/22/2015
Last updated
08/28/2024
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