Provider Demographics
NPI:1508898974
Name:SHONNARD, KEITH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:SHONNARD
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:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-2087
Mailing Address - Country:US
Mailing Address - Phone:775-882-0430
Mailing Address - Fax:775-852-6902
Practice Address - Street 1:2874 N CARSON ST STE 300
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1683
Practice Address - Country:US
Practice Address - Phone:775-888-1180
Practice Address - Fax:775-852-6902
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG874032085R0202X
NV73982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK658YOtherMEDICARE PTAN
NV002013091Medicaid
CAFS4913489OtherMEDI-CAL
NV300064321OtherRAILROAD MEDICARE
CAFS4913489OtherMEDI-CAL
NV002013091Medicaid