Provider Demographics
NPI:1770542912
Name:SHANNON, STRATTON JOHN (DO)
Entity type:Individual
Prefix:
First Name:STRATTON
Middle Name:JOHN
Last Name:SHANNON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0099
Mailing Address - Country:US
Mailing Address - Phone:207-794-6700
Mailing Address - Fax:207-794-6777
Practice Address - Street 1:175 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-0000
Practice Address - Country:US
Practice Address - Phone:207-794-6700
Practice Address - Fax:207-794-6691
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME035045OtherANTHEM
ME331270099Medicaid
ME201837OtherNGS
ME201837OtherNGS
MEG82437Medicare UPIN