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NPI Code Detail

MEDICARE: DR. WALTER ROWEN SHELTON II MD

MEDICARE: DR. WALTER ROWEN SHELTON II MD
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
1207X00000XOrthopaedic Surgery Physician7054MS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2200010805OTHERMSMEDICARE RR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578551792
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WALTER ROWEN SHELTON II MD
Provider Business Mailing Address
First Line : 1325 E FORTIFICATION ST
Second Line :
City : JACKSON
State : MS
Zip : 39202-2442
Country : US
Telephone Number : 601-354-4488
Fax Number : 601-914-1851
Provider Business Practice Location Address
First Line : 1325 E FORTIFICATION ST
Second Line :
City : JACKSON
State : MS
Zip : 39202-2442
Country : US
Telephone Number : 601-354-4488
Fax Number : 601-914-1851
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 11/17/2011

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