Individual
MR. ROBERT P SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G0922
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0053NG
BCBS
TX
05
—
033213202
—
TX
05
—
033213203
—
TX
01
—
4617433
AETNA
TX
Enumeration date
11/09/2006
Last updated
12/04/2012
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