Individual
DR. JERRY KEITH SHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2254 OLYMPIC ST, SPRINGFIELD, OH 45503-2737
(937) 399-8287
(937) 399-1670
Mailing address
2254 OLYMPIC ST, SPRINGFIELD, OH 45503-2737
(937) 399-8287
(937) 399-1670
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
35045125S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0431474
—
OH
Enumeration date
05/24/2005
Last updated
07/09/2007
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