Basic Information
| Provider Information | |||||||||
| NPI: | 1508898974 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHONNARD | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2087 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897022087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758820430 | ||||||||
| FaxNumber: | 7758526902 | ||||||||
| Practice Location | |||||||||
| Address1: | 2874 N CARSON ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897061683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758881180 | ||||||||
| FaxNumber: | 7758526902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 12/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | G87403 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 7398 | NV | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | CK658Y | 01 | CA | MEDICARE PTAN | OTHER | 002013091 | 05 | NV | MEDICAID | FS4913489 | 01 | CA | MEDI-CAL | OTHER | 300064321 | 01 | NV | RAILROAD MEDICARE | OTHER |