Individual
JAMES MASON SHELLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 E PRIMROSE ST STE 550, SPRINGFIELD, MO 65807-5180
(417) 269-4647
(417) 269-8078
Mailing address
1000 E PRIMROSE ST STE 300, SPRINGFIELD, MO 65807-5178
(417) 269-4646
(417) 269-8078
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
107697
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
159012
BLUECROSS BLUESHIELD
MO
01
—
421539307
FED TAX ID
MO
Enumeration date
11/07/2006
Last updated
07/19/2010
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