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General NPI Number Information
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NPI Number | 1316309925
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Entity Type | Individual
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Provider Name | PETER SHELTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1 BARNES JEW HOSP PLZ
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1003
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Country | US
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Telephone | 314-362-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 660 SOUTH EUCLID AVENUE MALLINCKRODT INSTITUTE OF RADIOLOGY
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City | ST LOUIS
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State | MO
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Zip | 63110
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Country | US
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Telephone | 314-362-5000
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | MD61228615
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License Number State | WA
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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 | 2018017520
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License Number State | MO
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