Doctor Name: | MARC E SHELTON |
NPI Number: | 1245313840 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 036-089250 |
Business Practice Address: | 619 E Mason St Suite 4p57 Springfield, IL - 627011034 |
Business Phone Number: | 2177880706 |
Business Fax Number: | 2175252535 |
Mailing Address: | 619 E Mason St, Suite 4p57 SPRINGFIELD |
State: | IL |
Postal Code: | 627011034 |
Phone Number: | 2177880706 |
Fax Number: | 2175252535 |
NPI Enumeration Date: | 10/24/2006 |
NPI Last Update Date: | 12/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 036-089250 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |