Provider Demographics
NPI:1740403013
Name:RICHARD P SHAUGHNESSY, IV D.O. PLLC
Entity Type:Organization
Organization Name:RICHARD P SHAUGHNESSY, IV D.O. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANAUSDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-254-6686
Mailing Address - Street 1:1300 N 12TH ST
Mailing Address - Street 2:#603
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2848
Mailing Address - Country:US
Mailing Address - Phone:602-254-6686
Mailing Address - Fax:602-254-4258
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:#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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3911207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX IDENTIFICATION NUMBER