Provider Demographics
NPI:1720171747
Name:MARTIN, SHANNON COLLEEN (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:COLLEEN
Last Name:MARTIN
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 1:300 S ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-2002
Mailing Address - Country:US
Mailing Address - Phone:775-348-1900
Mailing Address - Fax:775-348-1904
Practice Address - Street 1:235 W 6TH ST
Practice Address - Street 2:SAINT MARYS REGIONAL MEDICAL CENTER
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4548
Practice Address - Country:US
Practice Address - Phone:775-770-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11804207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology