Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 24151 | OK |
NPI | 1194864074 |
---|---|
Provider Name | Jeffrey Wayne Shelton |
First Address | Edmond, OK 73012-2069 |
Second Address | Edmond, OK 73012-2069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 02/05/2012 |