Individual
DR. DUSTIN SHACKLETON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10123 SE MARKET ST, PORTLAND, OR 97216-2532
(310) 225-3244
(310) 698-7054
Mailing address
2374 E PACIFICA PL, RANCHO DOMINGUEZ, CA 90220-6214
(310) 225-3244
(310) 698-7054
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
LL17906
OR
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MD150243
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DE3973
—
OR
Enumeration date
12/02/2008
Last updated
06/14/2021
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