Individual
ALEX H. SHACKLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
ECCLES INSTITUTE OF HUMAN GENETICS: 15 N MEDICAL DR RM, SALT LAKE CITY, UT 84112-4108
(801) 581-2121
Mailing address
ECCLES INSTITUTE OF HUMAN GENETICS: 15 N MEDICAL DR RM, SALT LAKE CITY, UT 84112-4108
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
207ZP0007X
Molecular Genetic Pathology (Pathology) Physician
Primary
14188290-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/30/2019
Last updated
03/11/2025
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