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General NPI Number Information
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NPI Number | 1679576656
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Entity Type | Individual
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Provider Name | ROBERT M SHUGART M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 7601 W JEFFERSON BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46804-4133
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Country | US
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Telephone | 260-436-8686
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Fax | 260-436-8585
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Provider Business Mailing Address
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Address Line | PO BOX 2526
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City | FORT WAYNE
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State | IN
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Zip | 46801-2526
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Country | US
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Telephone | 260-436-8686
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Fax | 260-436-8585
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 01041990A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 01041990A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 4301096712
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License Number State | MI
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