Organization
EUFAULA FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD SHACK MD (OWNER)
(334) 687-0112
Entity
Organization
Contact information
Practice address
617 E BROAD ST, B, EUFAULA, AL 36027
(334) 687-0112
(334) 687-0113
Mailing address
617 E BROAD ST, B, EUFAULA, AL 36027
(334) 687-0112
(334) 687-0113
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22858
AL
Other
Enumeration date
07/03/2007
Last updated
08/22/2020
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