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General NPI Number Information
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NPI Number | 1770546293
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Entity Type | Organization
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Legal Business Name | SHELBY BONE AND JOINT CLINIC, P.A.
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 807 SCHENCK ST STE 2
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City | SHELBY
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State | NC
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Zip | 28150-5123
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Country | US
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Telephone | 704-482-7311
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Fax | 704-487-0339
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Provider Business Mailing Address
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Address Line | 807 SCHENCK ST, SUITE 2
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City | SHELBY
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State | NC
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Zip | 28150-3933
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Country | US
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Telephone | 704-482-7311
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Fax | 704-487-0339
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YVES BOUDREAU
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Credential | MD
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Telephone | 704-482-7311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NC
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