Individual
RACQUEL D INNIS-SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
619 19TH ST S, BIRMINGHAM, AL 35249-1900
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
(205) 297-9411
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
28895
AL
390200000X
Student in an Organized Health Care Education/Training Program
0116018506
VA
390200000X
Student in an Organized Health Care Education/Training Program
28895
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04523704
—
MS
01
—
051598336
BLUE CROSS & BLUE SHIELD AL
AL
01
—
051598338
BLUE CROSS & BLUE SHIELD AL
AL
01
—
051598339
BLUE CROSS & BLUE SHIELD AL
AL
01
—
051598340
BLUE CROSS & BLUE SHIELD AL
AL
01
—
102I014862
MEDICARE
—
05
—
110794
—
AL
05
—
110861
—
AL
05
—
110869
—
AL
05
—
110873
—
AL
Enumeration date
05/03/2007
Last updated
01/31/2024
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