Healthcare Provider Details

I. General information

NPI: 1316870231
Provider Name (Legal Business Name): ROBERT MCDOWELL SHUGART II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 W JEFFERSON BLVD
FORT WAYNE IN
46804-6897
US

IV. Provider business mailing address

13822 LIBERTY MILLS RD
FORT WAYNE IN
46814-9433
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-0561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: