Healthcare Provider Details

I. General information

NPI: 1467538959
Provider Name (Legal Business Name): SHELBY G BRUTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 EAST COY SMITH HIGHWAY
MT VERNON AL
36560
US

IV. Provider business mailing address

725 EAST COY SMITH HIGHWAY
MT VERNON AL
36560
US

V. Phone/Fax

Practice location:
  • Phone: 251-662-6700
  • Fax: 251-829-5385
Mailing address:
  • Phone: 251-662-6700
  • Fax: 251-829-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number00006576
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: