STAG BLAIR SHADDUCK

EDGEWOOD, KY
NPI1962093674
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: KY  TC072)
Enumeration Date2021-01-27
Last Update Date2021-08-18
Business Address
STAG BLAIR SHADDUCK
560 S LOOP RD
EDGEWOOD, KY 41017-3405
Phone number: 859-301-2663
Mailing Address
STAG BLAIR SHADDUCK
560 S LOOP RD
EDGEWOOD, KY 41017-3405
Phone number: 859-301-2663
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