MEDICARE: DR. LINDA CAROL SHACKELFORD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider	J3603	TX

General Provider Information

NPI Number	:	1639283815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA CAROL SHACKELFORD MD

Provider Business Mailing Address
First Line	:	15111 HARNESS LN
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-1801
Country	:	US
Telephone Number	:	832-741-3187
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 NASA PKWY
Second Line	:	MAIL CODE SK
City	:	HOUSTON
State	:	TX
Zip	:	77058-3607
Country	:	US
Telephone Number	:	281-483-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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