Provider Demographics
NPI:1497720221
Name:BROWNFIELD, SHANNON H (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:H
Last Name:BROWNFIELD
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 1:1879 HENLEY DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-4305
Mailing Address - Country:US
Mailing Address - Phone:870-741-8247
Mailing Address - Fax:870-741-3933
Practice Address - Street 1:715 W SHERMAN AVE
Practice Address - Street 2:SUITE G
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2743
Practice Address - Country:US
Practice Address - Phone:870-741-8247
Practice Address - Fax:870-741-3933
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145733001Medicaid
AR145733001Medicaid
AR5M014Medicare PIN