Most Relevant Information
Provider Data
| NPI Number: | 1003227380 |
| Provider Name: | SHANNON DAVID AT |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/08/2014 |
| Last Updated: | 05/08/2014 |
Provider Practice Location
1301 CENTENNIAL BLVD BBFH # 1
FARGO
ND
581086050
Practice Location Phone/Fax
| Phone: | 7012315686 |
| Fax: |
Provider Mailing Location
PO BOX 6050
FARGO
ND
581086050
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |