Dermatology
MOUNTAIN WEST DERM - BLACKHART PLLC
Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1891467577 · enumerated 2021-10-01 · record updated 2021-10-04. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Authorized official: JEFFREY SHACKELTON MD, Owner · (775) 283-4086
Addresses and phones
- Practice location 341 NW MEDICAL LOOP STE 110, ROSEBURG, OR, 97471-5546 (541) 440-2165 Fax (541) 440-8932 Google Maps Apple Maps OpenStreetMap
- Mailing address 341 NW MEDICAL LOOP STE 110, ROSEBURG, OR, 97471-5546 Google Maps Apple Maps OpenStreetMap
Specialties
- Dermatology 207N00000X · Primary
In this directory
Locations and evidence
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Practice location
ROSEBURG, OR, 974715546
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.