Individual
MR. PAUL ANTHONY SHAKSTAD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5700 E HIGHWAY 90, SIERRA VISTA, AZ 85635-9110
(520) 263-2000
Mailing address
409 S LENZNER AVE APT 7205, SIERRA VISTA, AZ 85635-5643
(310) 529-1614
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
6821
AZ
363A00000X
Physician Assistant
Primary
PA-2570
ID
Other
Enumeration date
10/30/2017
Last updated
08/21/2023
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