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NPI Code Detail

MEDICARE: DALLAS R SHECKLER PA

MEDICARE: DALLAS R SHECKLER PA
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
1363A00000XPhysician Assistant673AK
2363A00000XPhysician Assistant99-PA24NM

General Provider Information

NPI Number : 1871586586
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALLAS R SHECKLER PA
Provider Business Mailing Address
First Line : 2510 W DUNLAP AVE
Second Line : STE 290
City : PHOENIX
State : AZ
Zip : 85021-2737
Country : US
Telephone Number : 602-789-0344
Fax Number : 602-789-8389
Provider Business Practice Location Address
First Line : 8208 LOUISIANA BLVD NE
Second Line : STE C
City : ALBUQUERQUE
State : NM
Zip : 87113-1757
Country : US
Telephone Number : 505-858-1222
Fax Number : 505-858-1224
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2005
Last Update Date : 08/11/2016

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Directions to “ DALLAS R SHECKLER PA” Practice Location

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