Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | LO25 | OK |
Y | 222Z00000X | Podiatrist | LO25 | OK |
NPI | 1023255767 |
---|---|
Provider Name | Kirby G Shelton |
First Address | Oklahoma City, OK 73118-5031 |
Second Address | Oklahoma City, OK 73118-5031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2009 |
Last Update Date | 16/01/2009 |