Individual
CLOUGH SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103
(801) 588-2700
Mailing address
PO BOX 581094, SALT LAKE CITY, UT 84158-1094
(801) 213-3800
Taxonomy
Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
Primary
267419-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003084600
—
ID
01
—
040006913
RAILROAD MEDICARE
UT
Enumeration date
10/13/2006
Last updated
06/18/2019
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