Healthcare Provider Details

I. General information

NPI: 1003076837
Provider Name (Legal Business Name): FRANK W. SHAGETS, JR., M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W 32ND ST SUITE B
JOPLIN MO
64804-2549
US

IV. Provider business mailing address

620 W 32ND ST SUITE B
JOPLIN MO
64804-2549
US

V. Phone/Fax

Practice location:
  • Phone: 417-623-5111
  • Fax: 417-623-1534
Mailing address:
  • Phone: 417-623-5111
  • Fax: 417-623-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberR8942
License Number StateMO

VIII. Authorized Official

Name: MRS. BETTY MCCOY
Title or Position: BACK OFFICE MANAGER
Credential: CST, MA
Phone: 417-623-5111