Shannon, Charles Roy

Shannon, Charles Roy is an individual health care provider with primary practice located at 2841 Debarr Road Suite 50, Anchorage AK 99508-2932. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Shannon, Charles Roy can be contacted via phone (907) 276-2811.

Contact Information

Primary practice address
2841 Debarr Road Suite 50 Anchorage AK 99508-2932
Phone: (907) 276-2811
Fax: (907) 276-2810
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 2099 Alaska

Profile Details

NPI number 1619959384
LBN Legal business name Shannon, Charles Roy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2005
Last updated Apr 24th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619959384 NPPES
Alaska MEDICAID MD20991

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