Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mountain West Derm - Blackhart PLLC

Organization Dermatology Physician · NPI 1891467577

Mountain West Derm - Blackhart PLLC is a Dermatology Physician in Roseburg, Oregon. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

341 NW Medical Loop Ste 110
Roseburg, OR 97471-5546
Phone: (541) 440-2165
Fax: (541) 440-8932
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X

Record details

NPI number1891467577
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeffrey Shackelton — Owner · (775) 283-4086
NPI enumeratedOctober 1, 2021
Last updated in NPPESOctober 4, 2021
Certification dateOctober 4, 2021
Mailing address341 Nw Medical Loop Ste 110, Roseburg, OR 97471-5546

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