Provider Demographics
NPI:1851391353
Name:PLATT, SHAWN G (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:G
Last Name:PLATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:520-306-3033
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:520-306-3033
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ72466OtherMEDICARE GROUP PTEN #
AZ518053Medicaid
AZZ72467OtherMEDICARE PTEN
AZ518053Medicaid