Individual
MS. MARION I SHELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
132 GARAU STREET, BLUFFTON PHYSICIANS INC, BLUFFTON, OH 45817-0069
(419) 358-5916
(419) 358-2302
Mailing address
PO BOX 69, BLUFFTON PHYSICIANS INC, BLUFFTON, OH 45817-0069
(419) 358-5916
(419) 358-2302
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34006706S
OH
208D00000X
General Practice Physician
34006706S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000129735
ANTHEM
OH
01
—
080142390
RAILROAD MEDICARE
OH
01
—
10799230
CAQH
OH
05
—
2048797
—
OH
Enumeration date
12/04/2006
Last updated
01/27/2010
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