DR. TYLER RAY SHACKELFORD


Address: 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM 87102-3619
Phone: 5057278206

DR. TYLER RAY SHACKELFORD (NPI# 1487996427) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1487996427
Entity Type Individual
Full Name DR. TYLER RAY SHACKELFORD
Credential DO
Practice Address 601 Dr Martin Luther King Jr Ave Ne
Albuquerque
NM 87102-3619
Mailing Address 4101 Indian School Rd Ne Ste 110
Albuquerque
NM 87110-3991
Practice Telephone 5057278206
Enumeration Date 2013-03-16
Last Update Date 2018-03-17
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RC0200X Internal Medicine
Specialization: Critical Care Medicine
A-20176-16 NM Allopathic & Osteopathic Physicians
N 390200000X Student in an Organized Health Care Education/Training Program R06-2013 NM Student, Health Care

Provider Secondary Practice Location

Address Telephone Number Fax Number
I University of New Mexico, Albuquerque, NM 871310001 5052726331 5052724628

Office Location

Street Address 601 DR MARTIN LUTHER KING JR AVE NE
City ALBUQUERQUE
State NM
Zip Code 87102-3619

Providers in the same location

NPI Name Taxonomy Address Enumeration
1649261611 Gilbert M Martinez Nuclear Medicine 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM 87102-3619 2005-10-31
1114533239 Mattie Firlit Dietitian, Registered 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM 87102-3619 2020-09-23
1184263303 Seth Tyler Gambone Nurse Anesthetist, Certified Registered 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM 87102-3619 2020-01-06
1518527530 Shannon Erickson Dietitian, Registered 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM 87102-3619 2019-06-20
1396218095 Caroline Jane Spencer Dietitian, Registered 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM 87102-3619 2019-01-04
1023596491 Jason Michael Rotonda Registered Nurse 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM 87102 2018-07-30
1275010985 Main Street Anesthesia of New Mexico, LLC Anesthesiology 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM 87102-3619 2018-07-25
1740779560 Paris Arlette Cook Pharmacist 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM 87102-3619 2018-05-07
1386150076 Raiza Stephanie Mena Registered Nurse 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM 87102-3619 2017-12-18
1255843710 Bernadette Perea-zamora Registered Nurse 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM 87102-3619 2017-10-24
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1407454937 Julie Wood Acupuncturist 1600 Luna Circle Nw, Albuquerque, NM 87102 2020-10-16
1770121410 Emily Perez Counselor 218 Broadway Ne, Albuquerque, NM 87102 2019-12-12
1417503392 Tess Holtry Behavior Technician 1424 Walter St Nw, Albuquerque, NM 87102 2019-08-15
1942867486 Christy E Cheromiah Behavioral Analyst Open Skies Helathcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 2019-05-21
1730744103 Faith Petra Maxwell Behavior Technician 900 Arno St, Albuquerque, NM 87102 2019-05-01
1568923761 Storm Swinford Behavioral Analyst Open Skies Healthcare, 707 Broadway Blvd Ne, Albuquerque, NM 87102 2019-03-29
1093276651 Tina Marie Trujillo Behavioral Analyst Open Skies Health Care, 707 Broadway Blvd Ne, Albuquerque, NM 87102 2019-03-27
1861950370 Meghan Montoya Student in an Organized Health Care Education/Training Program 801 Camino De Salud, Albuquerque, NM 87102 2019-03-05
1174099329 Dilshani N Tyson Counselor 600 1st Street Nw Ste 200, Albuquerque, NM 87102 2018-10-15
1962987925 Tania L Goldfeder Social Worker New Mexico Solutions, 707 Broadway Ne Suite 500, Albuquerque, NM 87102 2018-09-26
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Taxonomy Information

Taxonomy Code 207RC0200X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Critical Care Medicine

Taxonomy Definition

An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1780869743 Nathan Dean Nielsen Internal Medicine Msc10-5550 1 University of New Mexico, Albuquerque, NM 87131 2008-01-08
1245255835 Michel A Boivin Internal Medicine 5-acc Msc 10 5550, 2211 Lomas Blvd. Ne, Albuquerque, NM 87131-0001 2006-07-13
1295706331 Harold Lawrence Groff Internal Medicine University of New Mexico Medical Center, Msc11 6093, Albuquerque, NM 87106 2006-01-27
1922574508 Richard Morgan Harlyn Internal Medicine 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 2018-10-22
1801311907 Sara Katelynn Lucero Internal Medicine 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 2017-08-09
1407141815 Sarah Kathleen Medrek Internal Medicine 1501 San Pedro Dr Se, Albuquerque, NM 87108-5153 2011-06-14
1992844922 Eleana M Zamora Internal Medicine Unm Hospital Internal Medicine, 2211 Lomas Blvd Ne Msc 10-5550, Albuquerque, NM 87131-0001 2007-02-06
1760577241 Chang-kun Charles Choi Internal Medicine 1100 Central Ave Se, Albuquerque, NM 87106-4930 2006-10-03
1922014646 Staci A Logue-johnson Internal Medicine 5150 Journal Center Blvd Ne, Albuquerque, NM 87109-5900 2006-08-01
1336155084 Betty Chang Internal Medicine 2211 Lomas Blvd Ne, Div. Pulm/cc Medicine, Msc 10-5550, Albuquerque, NM 87106-2745 2006-08-01
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Competitor

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City ALBUQUERQUE
Zip Code 87102

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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