| Dr Shannon R Staker, MD | |
|
210 W 300 N 75-3, Roosevelt, UT 84066 | |
| (435) 722-3971 | |
| (435) 722-6104 |
| Full Name | Dr Shannon R Staker |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 210 W 300 N 75-3, Roosevelt, Utah |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023078045 | NPI | - | NPPES |
| D3849 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 49110641205 (Utah) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Shannon R Staker, MD 210 W 300 N 75-3, Roosevelt, UT 84066 Ph: (435) 722-3971 | Dr Shannon R Staker, MD 210 W 300 N 75-3, Roosevelt, UT 84066 Ph: (435) 722-3971 |
Kyler Black, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 250 W 300 N, Roosevelt, UT 84066 Phone: 435-722-4691 | |
Dr. Jason S Beales, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 210 W 300 N 75-3, Roosevelt, UT 84066 Phone: 435-722-3971 Fax: 435-722-6104 |