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NPI Code Detail

MEDICARE: JAMES B SHACKSON M.D.

MEDICARE: JAMES B SHACKSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianEMC0005754MI
22084P0800XPsychiatry Physician01045038AIN
32084P0800XPsychiatry Physician04-52327KS
42084P0800XPsychiatry Physician67932TN
52084P0800XPsychiatry PhysicianMD487198CPA
62084P0800XPsychiatry Physician35-062208OH
72084P0800XPsychiatry PhysicianC1406KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DF6496OTHEROHRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831185545
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES B SHACKSON M.D.
Provider Business Mailing Address
First Line : PO BOX 11167
Second Line :
City : FORT WAYNE
State : IN
Zip : 46856-1167
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Provider Business Practice Location Address
First Line : 21 E STATE ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-4281
Country : US
Telephone Number : 574-546-1900
Fax Number : 574-546-1999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 01/16/2026

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