Individual
DR. JAMES RYAN SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 N RAYMOND ST, BOISE, ID 83704
(208) 514-2500
(208) 375-2217
Mailing address
1525 S OWYHEE ST, BOISE, ID 83705-6014
(208) 297-3698
(208) 561-8051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
NONE
CA
2084P0800X
Psychiatry Physician
Primary
M-13301
ID
2084P0800X
Psychiatry Physician
NONE
CA
Other
Enumeration date
02/02/2007
Last updated
12/20/2023
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