Individual
DR. JUSTIN THOMAS SHATTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
54 HOSPITAL DR, STE 205, OSAGE BEACH, MO 65065-3050
(573) 302-2299
(573) 302-2296
Mailing address
PO BOX 1500, OSAGE BEACH, MO 65065-1500
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2012011181
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518187467
—
MO
Enumeration date
04/25/2007
Last updated
09/25/2012
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