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General NPI Number Information
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NPI Number | 1164418067
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Entity Type | Organization
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Legal Business Name | WILLIAM H SHACKELFORD MD
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 525 N VINE ST
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City | ARTHUR
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State | IL
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Zip | 61911-1137
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Country | US
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Telephone | 217-543-3628
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Fax | 217-543-2921
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Provider Business Mailing Address
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Address Line | 525 N VINE ST
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City | ARTHUR
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State | IL
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Zip | 61911-1137
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Country | US
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Telephone | 217-543-3628
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Fax | 217-543-2921
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM H SHACKELFORD
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Credential | MD
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Telephone | 217-543-3628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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