Individual
BLAIR SHACKLETON PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8440 WALNUT HILL LN STE 610, DALLAS, TX 75231-3815
(214) 345-6000
(214) 345-6026
Mailing address
8440 WALNUT HILL LN STE 610, DALLAS, TX 75231-3815
(214) 345-6000
(214) 345-6026
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA09776
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
354191401
—
TX
Enumeration date
03/24/2015
Last updated
02/20/2019
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