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NPI Code Detail

MEDICARE: JACK BARNETT SHELTON JR. MD

MEDICARE: JACK BARNETT SHELTON JR. 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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician47456MN

General Provider Information

NPI Number : 1184617227
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK BARNETT SHELTON JR. MD
Provider Business Mailing Address
First Line : 2800 10TH AVE S STE 2200
Second Line : HOSPITAL PATHOLOGY ASSOC
City : MINNEAPOLIS
State : MN
Zip : 55407-1311
Country : US
Telephone Number : 612-767-8370
Fax Number : 612-767-8376
Provider Business Practice Location Address
First Line : 2800 10TH AVE S STE 2200
Second Line : HOSPITAL PATHOLOGY ASSOC
City : MINNEAPOLIS
State : MN
Zip : 55407-1311
Country : US
Telephone Number : 612-767-8370
Fax Number : 612-767-8376
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 08/26/2020

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