Provider Demographics
NPI:1205817186
Name:SCHACKMUTH, ERIC M (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:SCHACKMUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5400 N GRAND BLVD
Mailing Address - Street 2:STE 260
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5705
Mailing Address - Country:US
Mailing Address - Phone:405-486-7250
Mailing Address - Fax:706-653-1567
Practice Address - Street 1:6250 US HIGHWAY 83
Practice Address - Street 2:ABILENE REGIONAL MEDICAL CENTER RADIOLOGY DEPARTMENT
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5215
Practice Address - Country:US
Practice Address - Phone:325-428-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK10492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F23959Medicare PIN
TXG68623Medicare UPIN