Basic Information
| Provider Information | |||||||||
| NPI: | 1013950906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHELTON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 TIMBERGREEN CIR | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762058530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403872412 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 W CHESTNUT ST | ||||||||
| Address2: | 1155 UNION CIRCLE #305160 | ||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405652333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 02/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | F4517 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 127786506 | 05 | TX | MEDICAID |