Individual
DERIC SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 502-1900
(918) 494-6303
Mailing address
1111 W 17TH ST, TULSA, OK 74107-1886
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
8040
OK
208M00000X
Hospitalist Physician
Primary
8040
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/06/2021
Last updated
10/20/2025
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