MEDICARE: DR. ANTHONY LEE SHELTON

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	208000000X	Pediatrics Physician	34719	OK
2	207R00000X	Internal Medicine Physician	34719	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34719	OTHER	OK	OKLAHOMA BOARD OF MEDICAL LICENSURE AND SUPERVISION

General Provider Information

NPI Number	:	1992365597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY LEE SHELTON

Provider Business Mailing Address
First Line	:	527 W 3RD ST
Second Line	:
City	:	KONAWA
State	:	OK
Zip	:	74849-1415
Country	:	US
Telephone Number	:	580-925-3286
Fax Number	:	580-925-2362

Provider Business Practice Location Address
First Line	:	1214 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-4045
Country	:	US
Telephone Number	:	580-436-5111
Fax Number	:	580-436-1159

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

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	10/18/2023

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