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Organization
STEVEN R. SHACKFORD MD PC
Active
Organization
STEVEN R. SHACKFORD MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN R SHACKFORD MD PC (OWNER/PRESIDENT)
(619) 299-2600
Entity
Organization
Contact information
Practice address
550 WASHINGTON ST., SUITE 641, SAN DIEGO, CA 92103-2229
(619) 299-2600
(619) 299-3923
Mailing address
550 WASHINGTON ST., SUITE 641, SAN DIEGO, CA 92103-2229
(619) 299-2600
(619) 299-3923
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
G29279
CA
2086S0129X
Vascular Surgery Physician
Primary
G29279
CA
Other
Enumeration date
08/13/2013
Last updated
08/13/2013
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