Provider Demographics
NPI:1366458036
Name:SHAWN G PLATT DO PLLC
Entity Type:Organization
Organization Name:SHAWN G PLATT DO PLLC
Other - Org Name:CORNERSTONE HEALTH AND FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIDENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:520-622-4580
Mailing Address - Street 1:2828 N STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-4503
Mailing Address - Country:US
Mailing Address - Phone:520-622-4580
Mailing Address - Fax:
Practice Address - Street 1:2828 N STONE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-4503
Practice Address - Country:US
Practice Address - Phone:520-622-4580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72467Medicare ID - Type Unspecified