Healthcare Provider Details

I. General information

NPI: 1982803698
Provider Name (Legal Business Name): JEREMY E SHELTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W HAMPDEN AVE SUITE 600
ENGLEWOOD CO
80110-2330
US

IV. Provider business mailing address

333 W HAMPDEN AVE SUITE 600
ENGLEWOOD CO
80110-2330
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-5646
  • Fax: 303-761-9280
Mailing address:
  • Phone: 303-761-5646
  • Fax: 303-761-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0052582
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberEC071067
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberEC101090
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: