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General NPI Number Information
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NPI Number | 1700171055
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Entity Type | Individual
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Provider Name | EDDIE LEE SHELTON A.T.P.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 4401 S PINEMONT DR STE 216
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City | HOUSTON
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State | TX
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Zip | 77041-9347
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Country | US
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Telephone | 713-835-3389
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Fax |
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Provider Business Mailing Address
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Address Line | 32003 ANNE LN
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City | PINEHURST
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State | TX
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Zip | 77362-4075
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Country | US
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Telephone | 713-828-6006
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Fax | 866-608-5543
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number | ATP 4300
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License Number State | TX
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