Provider Demographics
NPI:1003023276
Name:JARRELL, SHELBY EDWARD III (MD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:EDWARD
Last Name:JARRELL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 CEDAR ST SE
Mailing Address - Street 2:SUITE 6600
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4917
Mailing Address - Country:US
Mailing Address - Phone:505-724-4300
Mailing Address - Fax:505-724-4384
Practice Address - Street 1:201 CEDAR ST SE
Practice Address - Street 2:SUITE 6600
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4917
Practice Address - Country:US
Practice Address - Phone:505-724-4300
Practice Address - Fax:505-724-4384
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0957207XX0005X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74881736Medicaid
NM391992YLBBMedicare PIN