Provider Demographics
NPI:1710407283
Name:DAVID SHASKEY MD LLC
Entity Type:Organization
Organization Name:DAVID SHASKEY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-631-5804
Mailing Address - Street 1:1121 E 3900 S STE 125
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1261
Mailing Address - Country:US
Mailing Address - Phone:801-631-5804
Mailing Address - Fax:
Practice Address - Street 1:1121 E 3900 S STE 125
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1261
Practice Address - Country:US
Practice Address - Phone:801-631-5804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181318-1205207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty