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General NPI Number Information
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NPI Number | 1194864074
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Entity Type | Individual
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Provider Name | JEFFREY WAYNE SHELTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 21236 LAKE SHADOWS DR
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City | EDMOND
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State | OK
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Zip | 73012-2069
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Country | US
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Telephone | 405-200-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 21236 LAKE SHADOWS DR
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City | EDMOND
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State | OK
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Zip | 73012-2069
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Country | US
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Telephone | 405-200-2663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 24151
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 24151
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License Number State | OK
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