MEDICARE: DR. DAN HUFF SHELL III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	MD13349	TN
2	208200000X	Plastic Surgery Physician	MD13349	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043316821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN HUFF SHELL III MD

Provider Business Mailing Address
First Line	:	1068 CRESTHAVEN RD STE 200
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-0845
Country	:	US
Telephone Number	:	901-761-4844
Fax Number	:	901-761-6929

Provider Business Practice Location Address
First Line	:	1068 CRESTHAVEN RD STE 200
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-0845
Country	:	US
Telephone Number	:	901-761-4844
Fax Number	:	901-761-6929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	10/09/2023

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