MEDICARE: DR. BRIAN AUSTIN SHELTON MD, CSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1124495858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN AUSTIN SHELTON MD, CSA

Provider Business Mailing Address
First Line	:	3507 PLUMB ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2927
Country	:	US
Telephone Number	:	713-665-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	3507 PLUMB ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2927
Country	:	US
Telephone Number	:	713-665-5315
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2015
Last Update Date	:	08/28/2015

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