# STEVEN R. SHACKFORD MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841623865
- **Authorized official:** STEVEN R SHACKFORD MD PC (OWNER/PRESIDENT)
- **Authorized official phone:** (619) 299-2600

## Contact information

- **Practice address:** 550 WASHINGTON ST., SUITE 641, SAN DIEGO, CA 92103-2229
- **Practice address phone:** (619) 299-2600
- **Practice address fax:** (619) 299-3923
- **Mailing address:** 550 WASHINGTON ST., SUITE 641, SAN DIEGO, CA 92103-2229
- **Mailing address phone:** (619) 299-2600
- **Mailing address fax:** (619) 299-3923

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | G29279 | CA | — |
| 2086S0129X | Vascular Surgery Physician | G29279 | CA | Yes |

## Other

- **Enumeration date:** 08/13/2013
- **Last updated:** 08/13/2013