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General NPI Number Information
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NPI Number | 1215263850
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Entity Type | Organization
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Legal Business Name | DR RICK SHACKET PLLC
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Dates
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Enumeration Date | 11/01/2009
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 1525 N GRANITE REEF RD STE 12
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-3998
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Country | US
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Telephone | 602-492-9919
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Fax | 602-263-3697
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Provider Business Mailing Address
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Address Line | 8 BILTMORE EST UNIT 201
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City | PHOENIX
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State | AZ
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Zip | 85016-2839
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Country | US
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Telephone | 602-920-1023
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Fax | 602-263-3697
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICK SHACKET
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Credential | D.O.
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Telephone | 602-492-9919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4257
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 4257
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License Number State | AZ
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