Healthcare Provider Details

I. General information

NPI: 1649277666
Provider Name (Legal Business Name): JOHN K. SHEKLETON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 W ORANGE GROVE RD STE 101
TUCSON AZ
85704-1289
US

IV. Provider business mailing address

1871 W ORANGE GROVE RD STE 101
TUCSON AZ
85704-1289
US

V. Phone/Fax

Practice location:
  • Phone: 520-219-8342
  • Fax: 520-219-7117
Mailing address:
  • Phone: 520-219-8342
  • Fax: 520-219-7117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number29600
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number29401
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: