Organization
MOUNTAIN WEST DERM-BLACKHART, PLLC
Active
Parent organization
MOUNTAIN WEST DERM-BLACKHART, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOUNTAIN WEST DERM-BLACKHART, PLLC
Authorized official
JEFFREY B SHACKELTON (OWNER)
(775) 283-4086
Entity
Organization
Contact information
Practice address
10215 SW HALL BLVD, TIGARD, OR 97223-8809
(503) 245-2415
(503) 244-5963
Mailing address
10215 SW HALL BLVD, TIGARD, OR 97223-8809
(503) 245-2415
(503) 244-5963
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
11/22/2022
Last updated
11/22/2022
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