Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 2007005956 | MO |
N | 222Z00000X | Podiatrist | 2007005956 | MO |
N | 213E00000X | Podiatrist | 218 | SD |
N | 222Z00000X | Podiatrist | 218 | SD |
Y | 213ES0103X | Foot & Ankle Surgery | 145 | WY |
N | 213ES0103X | Foot & Ankle Surgery | 2007005956 | MO |
N | 213ES0103X | Foot & Ankle Surgery | 218 | SD |
NPI | 1043411523 |
---|---|
Provider Name | Dr. Brandon Chad Shelley |
First Address | Rock Springs, WY 82901-4771 |
Second Address | Rock Springs, WY 82901-4771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 19/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35666011 | BC/BS OF KANSAS (01) | MO |
5648250001 | NORDIAN ADMINISTRATIVE (01) | MO |
S107813 | (02) | SD |