Provider Demographics
NPI:1689776254
Name:SHAUGHNESSY, RICHARD PATRICK IV (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PATRICK
Last Name:SHAUGHNESSY
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3020 E CAMELBACK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5059
Mailing Address - Country:US
Mailing Address - Phone:602-264-9100
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:SUITE 603
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-254-6686
Practice Address - Fax:602-254-4258
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2017-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine