Provider Demographics
NPI:1730507740
Name:PATTERSON, SHANNAN (MD)
Entity type:Individual
Prefix:
First Name:SHANNAN
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 W RIVER RD STE 126
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3080
Mailing Address - Country:US
Mailing Address - Phone:520-219-6616
Mailing Address - Fax:520-742-6187
Practice Address - Street 1:3870 W RIVER RD STE 126
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3080
Practice Address - Country:US
Practice Address - Phone:520-219-6616
Practice Address - Fax:520-742-6187
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0065398208M00000X
MT1730507740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine