MEDICARE: ROBERT P SHACKELFORD 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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1902930712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT P SHACKELFORD M D

Provider Business Mailing Address
First Line	:	113 MEDICAL CIR
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2138
Country	:	US
Telephone Number	:	903-439-6302
Fax Number	:	903-439-2765

Provider Business Practice Location Address
First Line	:	113 MEDICAL CIR
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2138
Country	:	US
Telephone Number	:	903-439-6302
Fax Number	:	903-439-2765

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. NANCY SHACKELFORD
Credential	:
Telephone Number	:	903-439-6305

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/30/2008

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