Provider Demographics
NPI:1083239537
Name:TIPTON, SHELBY RENEE (DO)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:RENEE
Last Name:TIPTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:R
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2905 N STONE CARVER DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-1415
Mailing Address - Country:US
Mailing Address - Phone:812-353-5252
Mailing Address - Fax:812-353-5774
Practice Address - Street 1:2905 N STONE CARVER DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-1415
Practice Address - Country:US
Practice Address - Phone:812-676-4715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02007102B207R00000X
TXBP10072222207R00000X
IN02007102A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine