Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD2014-0957 | NM |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD2014-0957 | NM |
NPI | 1003023276 |
---|---|
Provider Name | Shelby Edward Jarrell III |
First Address | Albuquerque, NM 87106-4917 |
Second Address | Albuquerque, NM 87106-4917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 16/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
74881736 | (05) | NM |