Provider Demographics
NPI:1316188337
Name:SHANNON SETZER M.D., P.C.
Entity Type:Organization
Organization Name:SHANNON SETZER M.D., P.C.
Other - Org Name:BIG SKY DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:VOIRIN
Authorized Official - Last Name:SETZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-587-7546
Mailing Address - Street 1:4515 VALLEY COMMONS DR STE 202
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4532
Mailing Address - Country:US
Mailing Address - Phone:406-587-7546
Mailing Address - Fax:406-585-5672
Practice Address - Street 1:4515 VALLEY COMMONS DR STE 202
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4532
Practice Address - Country:US
Practice Address - Phone:406-587-7546
Practice Address - Fax:406-585-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11661261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center