Healthcare Provider Details

I. General information

NPI: 1871896837
Provider Name (Legal Business Name): SHELTON JOHN FRASER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FALCON PARKWAY
SCHRIEVER SFB CO
80912
US

IV. Provider business mailing address

220 FALCON PARKWAY
SCHRIEVER SFB CO
80912
US

V. Phone/Fax

Practice location:
  • Phone: 719-567-3250
  • Fax:
Mailing address:
  • Phone: 719-567-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: