Individual
DARREL BRUCE SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01031181A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109395
ANTHEM
IN
05
—
100145050
—
IN
01
—
64756182
KY MEDICAID
KY
Enumeration date
12/04/2006
Last updated
01/09/2013
Update your record
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