Individual
JOHN P SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 W POPLAR, SUITE 210, WALLA WALLA, WA 99362
(509) 522-5825
(509) 529-3512
Mailing address
PO BOX 2292, WALLA WALLA, WA 99362
(509) 522-5815
(509) 522-5818
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
15136
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1696004
—
WA
Enumeration date
07/31/2006
Last updated
03/31/2021
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