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General NPI Number Information
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NPI Number | 1740403013
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Entity Type | Organization
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Legal Business Name | RICHARD P SHAUGHNESSY, IV D.O. PLLC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 1300 N 12TH ST #603
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City | PHOENIX
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State | AZ
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Zip | 85006-2848
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Country | US
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Telephone | 602-254-6686
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Fax | 602-254-4258
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Provider Business Mailing Address
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Address Line | 1300 N 12TH ST #603
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City | PHOENIX
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State | AZ
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Zip | 85006-2848
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Country | US
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Telephone | 602-254-6686
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Fax | 602-254-4258
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEANNE M VANAUSDAL
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Credential |
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Telephone | 602-254-6686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 3911
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License Number State | AZ
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