Stag Shadduck

NPI 1962093674 · on the registry since 2021 · sole proprietor

Practice

Address: 560 S Loop Rd
Edgewood, KY 41017
Phone: (859) 301-2663
Fax: (859) 817-7848
Organisation at this address: Gaitwell Orthotics And Pedorthics
Orthocincy Orthopaedics & Sports Medicine
Orthocincy Orthopaedics & Sports Medicine
Orthocincy Orthopaedics & Sports Medicine Psc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 87

Registry record

Primary taxonomy: Physician Assistant
363A00000X
Licence states on file: KY
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2021-08-18

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Kentucky