Provider Demographics
NPI:1376982652
Name:SHAKURI-RAD, JASCHAR (DO)
Entity Type:Individual
Prefix:DR
First Name:JASCHAR
Middle Name:
Last Name:SHAKURI-RAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 J D ANDERSON DR STE 401
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1238
Mailing Address - Country:US
Mailing Address - Phone:304-599-3074
Mailing Address - Fax:304-599-1802
Practice Address - Street 1:1000 J D ANDERSON DR STE 401
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-3074
Practice Address - Fax:304-599-1802
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3294208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology