Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 30197 | AL |
NPI | 1083871131 |
---|---|
Provider Name | Dr. Grantham Mcaleer Shell |
First Address | Mobile, AL 36604-1410 |
Second Address | Mobile, AL 36604-1410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2008 |
Last Update Date | 12/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160835 | (05) | AL |