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General NPI Number Information
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NPI Number | 1710407283
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Entity Type | Organization
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Legal Business Name | DAVID SHASKEY MD LLC
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 06/26/2017
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Provider Practice Location Address
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Address Line | 1121 E 3900 S STE 125
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1261
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Country | US
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Telephone | 801-631-5804
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 E 3900 S STE 125
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1261
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Country | US
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Telephone | 801-631-5804
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID SHASKEY
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Credential | MD
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Telephone | 801-631-5804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 181318-1205
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License Number State | UT
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