Provider Demographics
NPI:1720052699
Name:SHANNON, DONNA ARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:ARLENE
Last Name:SHANNON
Suffix:
Gender:F
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 9101
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9494
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-471-0700
Practice Address - Street 1:345 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2134
Practice Address - Country:US
Practice Address - Phone:972-956-5300
Practice Address - Fax:972-956-5393
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164476702Medicaid
TX8K2772OtherBC/BS
TX164476701OtherMEDICAID FOR DALLAS COUNTY
TX8B5494OtherMEDICARE FOR DALLAS COUNTY
TXI03231Medicare UPIN
TX164476702Medicaid