Provider Demographics
NPI:1801819743
Name:CORRIGAN, SHANNON TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:TAYLOR
Last Name:CORRIGAN
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 24584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0584
Mailing Address - Country:US
Mailing Address - Phone:425-656-4255
Mailing Address - Fax:425-656-4003
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:ER DEPT
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-228-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041173207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8317091Medicaid
WA0185268OtherLABOR&IND PROV BILLING #
WA5532COOtherREGENCE BS PROV #
WA0185268OtherLABOR&IND PROV BILLING #
WAGAB33103Medicare ID - Type UnspecifiedPART B MED PROV #