Individual
DR. TYLER RAY SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
601 DR MARTIN LUTHER KING JR AVE NE, ALBUQUERQUE, NM 87102-3619
(505) 727-8206
Mailing address
4101 INDIAN SCHOOL RD NE STE 110, ALBUQUERQUE, NM 87110-3991
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
A-20176-16
NM
390200000X
Student in an Organized Health Care Education/Training Program
R06-2013
NM
Other
Enumeration date
03/16/2013
Last updated
03/17/2018
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