| NPI | 1215263850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICK SHACKET Owner 602-492-9919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: AZ 4257) |
| Additional Taxonomies | 207N00000X Dermatology |
| 207Q00000X Family Medicine (Licence: AZ 4257) | |
| Enumeration Date | 2009-11-01 |
| Last Update Date | 2021-10-04 |