Basic Information
| Provider Information | |||||||||
| NPI: | 1407834849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHELL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1068 | ||||||||
| Address2: | |||||||||
| City: | SIKESTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638011068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734310330 | ||||||||
| FaxNumber: | 5734722966 | ||||||||
| Practice Location | |||||||||
| Address1: | 1012 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SIKESTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638015044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734310330 | ||||||||
| FaxNumber: | 5734722966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207R00000X | MD28469 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 43074141063801A085 | 01 | MO | TRICARE | OTHER | 132510 | 01 | MO | HEALTHLINK NUMBER | OTHER | 27441 | 01 | MO | BCBS MO NUMBER | OTHER |