Individual
JOHN H SHACKELFORD JR.
Active
Individual
JOHN H SHACKELFORD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
220500
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2104296
—
MA
01
—
AA35717
HPHC
MA
01
—
J28724
BCBS
MA
Enumeration date
03/22/2006
Last updated
06/17/2019
Update your record
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