Individual
DR. STEVEN R. SHACKFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
07/27/2006
Last updated
04/12/2013
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