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General NPI Number Information
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NPI Number | 1972789832
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Entity Type | Organization
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Legal Business Name | THE PHYSICIAN & TUTOR, P.A.
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 690 E LAMAR BLVD SUITE 117
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City | ARLINGTON
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State | TX
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Zip | 76011-3882
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Country | US
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Telephone | 817-548-0504
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Fax | 817-861-8845
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Provider Business Mailing Address
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Address Line | 690 EAST LAMAR BOULEVARD SUITE 117
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City | ARLINGTON
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State | TX
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Zip | 76011-3882
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Country | US
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Telephone | 817-548-0504
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Fax | 817-861-8845
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Authorized Official
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Title or Position | CEO & OWNER
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Name | ANNETTE MARIE SHELTON
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Credential | M.D.
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Telephone | 817-548-0504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G5606
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License Number State | TX
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