Basic Information
| Provider Information | |||||||||
| NPI: | 1134151038 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHELTON | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30809 1ST AVE S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980034074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538392030 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 30809 1ST AVE S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980034074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538392030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 03/23/2012 | ||||||||
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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 | OP00000916 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0199174 | 01 | WA | L & I | OTHER | 8906585 | 01 | WA | CRIME VICTIMS | OTHER | P00338282 | 01 | WA | RAILROAD | OTHER | 0290136 | 01 | WA | L&I | OTHER | 1819309 | 05 | WA | MEDICAID | 0290137 | 01 | WA | L&I | OTHER | G8906803 | 01 | WA | MEDICARE | OTHER |