Provider Demographics
NPI:1023224250
Name:SHELL, DANIEL HUFF IV (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:HUFF
Last Name:SHELL
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SIVLEY ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3123
Mailing Address - Country:US
Mailing Address - Phone:662-236-6465
Mailing Address - Fax:
Practice Address - Street 1:2716 W OXFORD LOOP
Practice Address - Street 2:SUITE 171
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5714
Practice Address - Country:US
Practice Address - Phone:662-236-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20125208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery