Provider Demographics
NPI:1639283815
Name:SHACKELFORD, LINDA CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:CAROL
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15111 HARNESS LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1801
Mailing Address - Country:US
Mailing Address - Phone:832-741-3187
Mailing Address - Fax:
Practice Address - Street 1:2101 NASA PKWY
Practice Address - Street 2:MAIL CODE SK
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3607
Practice Address - Country:US
Practice Address - Phone:281-483-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3603171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider