Provider Demographics
NPI:1669785937
Name:SCHANNEN, ANDREW PHILLIP (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PHILLIP
Last Name:SCHANNEN
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 1:1248 N NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-4715
Mailing Address - Country:US
Mailing Address - Phone:802-310-1674
Mailing Address - Fax:
Practice Address - Street 1:2100 LOUISIANA BLVD NE STE 410
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5412
Practice Address - Country:US
Practice Address - Phone:505-724-4300
Practice Address - Fax:505-338-0034
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2016-0639207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery