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General NPI Number Information
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NPI Number | 1326034232
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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 | 08/22/2020
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Provider Practice Location Address
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Address Line | 208 S JACKSON ST
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City | CERRO GORDO
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State | IL
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Zip | 62501
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Country | US
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Telephone | 217-763-5851
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Fax | 217-763-2201
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Provider Business Mailing Address
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Address Line | PO BOX 20
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City | CERRO GORDO
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State | IL
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Zip | 61818-0020
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Country | US
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Telephone | 217-763-5851
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Fax | 217-763-2201
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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 | 217-763-5851
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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 |
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